Effect of Waist Circumference on Mortality and Morbidity in Patients with Acute Coronary Syndrome with St-Segment Elevation

Abstract

Aim: Obesity is a known risk factor for cardiovascular diseases. However, there are also studies showing that increased body mass index is unexpectedly protective in myocardial infarction. More studies are needed to elucidate this situation, known as the obesity paradox. This study was conducted to investigate the relationship between waist circumference and mortality and morbidity in acute ST elevated myocardial infarct (STEMI). Material and Method: This is a prospective and observational study. Patients diagnosed with STEMI on electrocardiography (ECG) were included in the study. Immediately after the exhalation, waist circumference (WC) was measured on a horizontal plane at a point equidistant from the lowest floating rib and the upper border of the iliac crest. The role of waist circumference in the development of mortality and major cardiac events within 1 month was evaluated. Results: A total of 106 patients admitted to the emergency department with STEMI were included in the study. While increased waist circumference was associated with mortality, it was insignificant in terms of major adverse cardiovascular event (MACE) development. Low BMI is significant in terms of decreased mortality and MACE. Conclusions: The use of WC as an indicator of body fat ratio rather than weight in STEMI may be more valuable in the evaluation of mortality and MACE.

Keywords

• Waist circumference
• mortality
• acute coronary syndrome
• obesity

St-Segment Yüksekliği Olan Akut Koroner Sendromlu Hastalarda Bel Çevresinin Mortalite ve Morbidite Üzerine Etkisi

Abstract

Amaç: Obezite kardiyovasküler hastalıklar için bilinen bir risk faktörüdür. Ancak artan vücut kitle indeksinin miyokard enfarktüsünde beklenmedik şekilde koruyucu olduğunu gösteren çalışmalar da mevcuttur. Obezite paradoksu olarak bilinen bu durumu aydınlatmak için daha fazla çalışmaya ihtiyaç vardır. Bu çalışma, akut ST yükselmeli miyokard enfarktüsünde (STEMI) bel çevresi ile mortalite ve morbidite arasındaki ilişkiyi araştırmak amacıyla yapılmıştır. Gereç ve Yöntem: Bu prospektif ve gözlemsel bir çalışmadır. Elektrokardiyografide STEMI tanısı alan hastalar çalışmaya dahil edildi. Ekshalasyondan hemen sonra, bel çevresi yatay bir düzlemde, en alttaki yüzen kaburgadan ve iliak krestin üst sınırından eşit uzaklıkta bir noktada ölçüldü. Bel çevresinin 1 ay içinde mortalite ve majör kardiyak olayların gelişimindeki rolü değerlendirildi. Bulgular: Acil servise STEMI ile başvuran toplam 106 hasta çalışmaya dahil edildi. Artan bel çevresi mortalite ile ilişkili iken majör anormal kardiyak olay (MAKO) gelişimi açısından önemsizdi. Düşük vücut kitle indeksi, azalmış mortalite ve MAKO açısından önemlidir. Sonuç: STEMI'de vücut ağırlığından ziyade vücut yağ oranının bir göstergesi olan bel çevresinin kullanılması mortalite ve majör kardiyak olayların değerlendirilmesinde daha değerli olabilir.

Keywords

• Bel çevresi
• mortalite
• akut koroner sendrom
• obezite

Supporting Institution

yok

References

1. Wang Y, Beydoun MA. The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics:a systematic review and meta-regression analysis. Epidemiol Rev 2007;29:6-28.
2. Wolk R, Berger P, Lennon RJ, Brilakis ES, Somers VK. Body mass index:a risk factor for unstable angina and myocardial infarction in patients with angiographically confirmed coronary artery disease. Circulation 2003;108:2206-11.
3. Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries:a case-control study. Lancet 2005;366:1640-9.
4. Diercks DB, Roe MT, Mulgund J, et al. The obesity paradox in non-ST-segment elevation acute coronary syndromes:results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J 2006;152:140-8.
5. Lancefield T, Clark DJ, Andrianopoulos N, et al. Is there an obesity paradox after percutaneous coronary intervention in the contemporary era? An analysis from a multicenter Australian registry. JACC Cardiovasc Interv 2010;3:660-8.
6. Kang WY, Jeong MH, Ahn YK, et al. Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Cardiol 2010;55:84-91.
7. Mornar Jelavić M, Babić Z, Pintarić H, Mišigoj-Duraković M. The Role of Anthropometry in Acute St-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. Acta Clin Croat 2016;55:224-32.
8. Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice:a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020;16:177-189.

9. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008;359:2105-20.
10. Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram:part III:intraventricular conduction disturbances:a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology;the American College of Cardiology Foundation;and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009;53:976-81.
11. Lahti-Koski M, Pietinen P, Heliövaara M, Vartiainen E. Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies. Am J Clin Nutr 2002;75:809-17.
12. Booth ML, Hunter C, Gore CJ, Bauman A, Owen N. The relationship between body mass index and waist circumference:implications for estimates of the population prevalence of overweight. Int J Obes Relat Metab Disord 2000;24:1058-61.
13. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults:executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 1998;68:899-917.
14. World Health Organization (WHO) Obesity:preventing and managing the global epidemic. Report of a WHO Consultation. Geneva:WHO;2000. [WHO Technical Report Series 894].
15. Zeller M, Steg PG, Ravisy J, et al. Relation between body mass index, waist circumference, and death after acute myocardial infarction. Circulation 2008;118:482-90.
16. Lubree HG, Rege SS, Bhat DS, et al. Body fat and cardiovascular risk factors in Indian men in three geographical locations. Food Nutr Bull 2002;23:146-9.
17. Adegbija O, Hoy W, Wang Z. Prediction of cardiovascular disease risk using waist circumference among Aboriginals in a remote Australian community. BMC Public Health 2015;15:57.
18. Ardahanli I, Ozkan HI. Comparison of Serum Selenium Levels Between Patients with Newly Diagnosed Atrial Fibrillation and Normal Controls. Biol Trace Elem Res 2022;200:3925-31.
19. 19-Olson KL, Neiberg RH, Espeland MA, et al. Waist Circumference Change During Intensive Lifestyle Intervention and Cardiovascular Morbidity and Mortality in the Look AHEAD Trial. Obesity (Silver Spring) 2020;28:1902-11.
20. Gurm HS, Whitlow PL, Kip KE;BARI Investigators. The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). J Am Coll Cardiol 2002;39:834-40.
21. Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention:the obesity paradox?. J Am Coll Cardiol 2002;39:578-84.
22. Martins A, Ribeiro S, Gonçalves P, Correia A. Role of central obesity in risk stratification after an acute coronary event:does central obesity add prognostic value to the Global Registry of Acute Coronary Events (GRACE) risk score in patients with acute coronary syndrome?. Rev Port Cardiol 2013;32:769-76.
23. Iakobishvili Z, Danicek V, Porter A, Assali AR, Battler A, Hasdai D. Is increased body mass index associated with a cardioprotective effect after ST-segment-elevation myocardial infarction?. Acute Card Care 2006;8:95-8.
24. Coutinho T, Goel K, Corrêa de Sá D, et al. Central obesity and survival in subjects with coronary artery disease:a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol 2011;57:1877-86.