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Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry.

Publication ,  Journal Article
Lowenstern, A; Ng, N; Takagi, H; Rymer, JA; Koweek, LM; Douglas, PS; Duran, JM; Rabbat, M; Pontone, G; Fairbairn, T; Chinnaiyan, K; Berman, DS ...
Published in: Circ Cardiovasc Imaging
May 2023

BACKGROUND: The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes. METHODS: The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had >30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal <25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2. Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFRCT), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes. RESULTS: Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all P<0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI; P<0.001). However, the rate of hemodynamic significance, as indicated by a positive FFRCT, was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI; P=0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3; P<0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all P>0.05). CONCLUSIONS: Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFRCT and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio.

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Published In

Circ Cardiovasc Imaging

DOI

EISSN

1942-0080

Publication Date

May 2023

Volume

16

Issue

5

Start / End Page

e014850

Location

United States

Related Subject Headings

  • Registries
  • Predictive Value of Tests
  • Overweight
  • Obesity
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Computed Tomography Angiography
 

Citation

APA
Chicago
ICMJE
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Lowenstern, A., Ng, N., Takagi, H., Rymer, J. A., Koweek, L. M., Douglas, P. S., … Daubert, M. A. (2023). Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry. Circ Cardiovasc Imaging, 16(5), e014850. https://doi.org/10.1161/CIRCIMAGING.122.014850
Lowenstern, Angela, Nicholas Ng, Hidenobu Takagi, Jennifer A. Rymer, Lynne M. Koweek, Pamela S. Douglas, Jessica M. Duran, et al. “Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry.Circ Cardiovasc Imaging 16, no. 5 (May 2023): e014850. https://doi.org/10.1161/CIRCIMAGING.122.014850.
Lowenstern A, Ng N, Takagi H, Rymer JA, Koweek LM, Douglas PS, et al. Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry. Circ Cardiovasc Imaging. 2023 May;16(5):e014850.
Lowenstern, Angela, et al. “Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry.Circ Cardiovasc Imaging, vol. 16, no. 5, May 2023, p. e014850. Pubmed, doi:10.1161/CIRCIMAGING.122.014850.
Lowenstern A, Ng N, Takagi H, Rymer JA, Koweek LM, Douglas PS, Duran JM, Rabbat M, Pontone G, Fairbairn T, Chinnaiyan K, Berman DS, De Bruyne B, Bax JJ, Akasaka T, Amano T, Nieman K, Rogers C, Kitabata H, Sand NPR, Kawasaki T, Mullen S, Matsuo H, Norgaard BL, Patel MR, Leipsic J, Daubert MA. Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry. Circ Cardiovasc Imaging. 2023 May;16(5):e014850.

Published In

Circ Cardiovasc Imaging

DOI

EISSN

1942-0080

Publication Date

May 2023

Volume

16

Issue

5

Start / End Page

e014850

Location

United States

Related Subject Headings

  • Registries
  • Predictive Value of Tests
  • Overweight
  • Obesity
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Computed Tomography Angiography