Interventional Cardiology

Obesity and Coronary Heart Disease

Until recently the relation between obesity and coronary heart disease was viewed as indirect, i.e., through covariates related to both obesity and coronary heart disease risk, including hypertension; dyslipidemia, particularly reductions in HDL cholesterol; and impaired glucose tolerance or non–insulin-dependent diabetes mellitus. Insulin resistance and accompanying hyperinsulinemia are typically associated with these comorbidities. Although most of the comorbidities relating obesity to coronary artery disease increase as BMI increases, they also relate to body fat distribution. Long-term longitudinal studies, however, indicate that obesity as such not only relates to but independently predicts coronary atherosclerosis. This relation appears to exist for both men and women with minimal increases in BMI. In a 14-year prospective study, middle-aged women with a BMI >23 but <25 had a 50% increase in risk of nonfatal or fatal coronary heart disease, and men aged 40 to 65 years with a BMI >25 but <29 had a 72% increased risk. The overall relation between obesity and coronary artery disease morbidity and mortality is less clear for Hispanics, Pima Indians, and African-American women