The Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry
Journal of the American College of Cardiology
Background: Associations between body mass index (BMI) and adverse cardiovascular (CV) events are unclear with some evidence suggesting an “obesity paradox,” such that patients with coronary artery disease (CAD) and a higher BMI may have better outcomes. We used data from the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry to evaluate CAD burden and clinical outcomes based on BMI. Methods: Patients in ADVANCE were stratified by BMI (normal <25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2). Baseline patient demographics, coronary computed tomography angiography (CCTA) findings, and fractional flow reserve derived from CTA (FFRCT) positivity (<0.8) were examined. An adjusted Cox proportional hazards model compared clinical outcomes between the groups using normal BMI as the reference. Results: Among 5,014 patients in ADVANCE with BMI data, 2,166 (43.2%) had a normal BMI, 1,883 (37.6%) were overweight, and 965 (19.2%) obese. Patients in the obese category were younger and had a higher burden of comorbidities (Table 1). Obese patients were less likely to have obstructive (≥50% stenosis) CAD by CCTA (P < 0.001). However, among the 4,665 patients with FFRCT measurements, hemodynamically significant CAD, as indicated by FFRCT <0.8, was similar across BMI categories (P = 0.113). After adjustment, the rate of major adverse CV events, including CV death, non-CV death, nonfatal myocardial infarction, and unplanned revascularization was similar regardless of BMI (P > 0.05 for all). Conclusion: Although obese patients in ADVANCE had a higher burden of comorbidities, they were less likely to have anatomically obstructive CAD but had a similar degree of hemodynamically significant CAD by FFRCT and similar rates of adverse events. This suggests that hemodynamic significance rather than anatomic stenosis may be a better predictor of CV outcomes among patients with obesity and CAD.
Lowenstern A, Takagi H, Ng N, Rymer J, Koweek L, Douglas P, Duran J, Rabbat M, Chinnaiyan K, Berman D, De Bruyne B. TCT-303 The Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry. Journal of the American College of Cardiology. 2021 Nov 9;78(19_Supplement_S):B124-5.