Shady Akl

Suez Canal University Hospitals, Egypt

Title: Effect of Abdominal Obesity On Patients with Myocardial Infarction

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Biography

Abstract

Background: Obesity is an excessive accumulation of fat that can impair health.

Alterations in cardiovascular function have been observed in obese patients.

Aim: Detect the potential effect of abdominal obesity on severity of myocardial infarction in patients with ST elevation myocardial infarction (STEMI).

Patients and Methods: This study was a cross-sectional study that included 114 patients with acute STEMI who attended to Coronary Care Unit (CCU) at Mansoura International Hospital. Included patients were divided into two groups: Group 1: patients who meet obesity criteria according to NCEP (n = 57) and Group 2: non obese patients (n = 57). The collected data included the medical history, clinical, laboratory, associated factors (DM, HTN, and Dyslipidemia), past history and family history of acute coronary syndrome. Results: Cardiac biomarkers were significantly higher in obese group rather than non-obese group regardless they had normal or overweight BMI. Conclusion: Presence of abdominal obesity is associated with greater myocardial necrosis after an acute coronary event.

Introduction: Abdominal obesity is the excessive accumulation of abdominal fat (visceral fat) resulting in an increase in waist size, over the past three decades, the worldwide prevalence of obesity has increased to alarming levels. In the USA, an estimated one-third of adults are obese. (1) The incidence rate of overweight has increased 2- fold and obesity more than 3-fold over the past 50 years. (2) In 2006, WHO estimates that the incidence of obesity has tripled over the past 20 years in developing countries, and projections predict that there will be 2.3 billion overweight (25–29.9 kg/m2) and 700 million obese (?30.0 kg/m2) individuals worldwide in 2015. (3)Abdominal obesity is one of the five clinical conditions (together with hypertriglyceridemia, higher cholesterol, lower high density lipoprotein (HDL), fasting hyperglycemia and hypertension) that define the existence of metabolic syndrome (MetS) according to the criteria established the National Cholesterol Education Program Adult Treatment Panel ((NCEP ATP III). (4)

Obesity and metabolic syndrome are major epidemics of the 21st century worldwide. (5,6) The metabolic syndrome (MetS) is characterized by a group of risk factors clustered in one individual, known to promote or increase the risk for development of diabetes mellitus and cardiovascular disease (CVD). (7, 8, 9)Studies in patients with established vascular disease (coronary, cerebral and peripheral) demonstrate that the presence of metabolic syndrome correlates with the degree of underlying atherosclerosis. (10) This indicates that some of the clinical conditions that make up the metabolic syndrome-called not only increase the risk of cardiovascular disease, but once an event occurs, its presence is associated with greater severity and worse prognosis . (11)

Coronary artery diseases (CAD) are the most common cause of mortality in the world, myocardial infarction (MI) is the most common subtype of CAD, in addition, the prevalence of (MI) is increasing in the developing countries, In recent years, metabolic syndrome (MetS) is introduced as one of the major risk factors for CAD. (12)

In individuals with MetS, the risk of death from CAD is about two fold higher than normal and their risk of MI and stroke is 3 times than the normal population. (13) It has been reported that patients with symptomatic vascular disease and MetS have higher probabilities of suffering from extensive vascular damage. (14, 15)

Patients and methods

Study design: This study was a cross-sectional study.

Study site: The study was conducted on patients with acute myocardial infarction (STEMI) in Coronary Care Unit (CCU) at Mansoura International Hospital.

Patient selection:114 Patients with STEMI were randomly included in the study. Included patients were divided into two groups:

Group 1: patients who meet obesity criteria according to NCEP - ATPIII (BMI ? 30 kg/m2 and/or WC ? 88 cm in women or ? 102 cm in men) (n = 57).

Group 2: non obese patients (n = 57).

Results: The study included one hundred and fourteen patients who presented to Mansoura General Hospital with acute STEMI. Patients were divided into two groups: group 1 were obese and group 2 non obese patients according to NCEP criteria. The mean age of the study population was 57.13±9.61 (28 – 80 years). Only 3 patients were between 18-39 years, 61 patients were between 40-59 years and 50 patients were above or equal to 60 years. 80 patients of the study population were males (70.18%) and 34 patients were females (29.82%). 

The mean of the BMI was higher in group 1 as expected than in group 2(30.77±0.52 versus 24.97±1.29). Male patients in group 1 had significant higher WC than males in group 2(106.59± 2.48 versus 92.61±5.08). Female patients in group 1 had significant higher WC than females in group 2(98.5±4.89 versus 85.86±1.41). (Table 2)

62.28% of the study population was smokers (all of them were males). 50% of the study population was hypertensive, 21.05% were diabetic and 24.56% were dislipidemic.14.04% of the study population has positive family history of CAD. HTN and DM were significantly high in group 1.