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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Obesity and Age of First Non–ST-Segment Elevation Myocardial Infarction

Mohan C. Madala, MD^_*, Barry A. Franklin, PhD^_*, Anita Y. Chen, MS, Aaron D. Berman, MD, FACC^_*, Matthew T. Roe, MD, Eric D. Peterson, MD, FACC, E. Magnus Ohman, MD, FACC, Sidney C. Smith, Jr, MD, FACC, W. Brian Gibler, MD, Peter A. McCullough, MD, FACC^_*,_* for the CRUSADE Investigators

^_* Department of Medicine, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Michigan
Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
University of North Carolina School of Medicine, Chapel Hill, North Carolina
University of Cincinnati College of Medicine, Cincinnati, Ohio

Manuscript received January 7, 2008; revised manuscript received April 4, 2008, accepted April 7, 2008.

^_* Reprint requests and correspondence: Dr. Peter A. McCullough, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, Michigan 48073 (Email: pmc975{at}yahoo.com).

Objectives: Because excess adiposity is one of the most important determinants of adipokines and inflammatory factors associated with coronary plaque rupture, we hypothesized that obesity was associated with myocardial infarction at earlier ages.

Background: The developing obesity pandemic of the past 50 years has gained considerable attention as a major public health threat.

Methods: The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) registry was a voluntary observational data collection and quality improvement initiative that began in November 2001, with retrospective data collection from January 2001 to January 2007. The CRUSADE initiative included high-risk patients with unstable angina and non–ST-segment elevation myocardial infarction (NSTEMI). We retrospectively examined, among 189,065 patients with acute coronary syndrome (between January 2001 and September 2006) in the CRUSADE initiative, the relationship of body mass index (BMI) with patient age of first NSTEMI.

Results: A total of 111,847 patients with NSTEMI were included in the final analysis. There was a strong, inverse linear relationship between BMI and earlier age of first NSTEMI. The mean patient ages (± SD) of first NSTEMI were 74.6 ± 14.3 years and 58.7 ± 12.5 years for the leanest (BMI 18.5 kg/m²) and most obese (BMI >40.0 kg/m²) cohorts, respectively (p < 0.0001). After adjustment for baseline demographic data, cardiac risk factors, and medications, the age of first NSTEMI occurred 3.5, 6.8, 9.4, and 12.0 years earlier with ascending levels of adiposity (BMI 25.1 to 30.0, 30.1 to 35.0, 35.1 to 40.0, and >40.0 kg/m², respectively; referent 18.6 to 25.0 kg/m²) (p < 0.0001 for each estimate).

Conclusions: Excess adiposity is strongly related to first NSTEMI occurring prematurely.

Key Words: acute coronary syndromes • age • body mass index • myocardial infarction • obesity • risk factors

Abbreviations and Acronyms   BMI = body mass index   hsCRP = high-sensitivity C-reactive protein   MI = myocardial infarction   NSTEMI = non–ST-segment elevation myocardial infarction

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