Body mass index and mortality in patients with severe coronary artery diseases: A cohort study from China

Aldehyde Dehydrogenase 2 rs671 Polymorphism is Associated with Susceptibility of Coronary Atherosclerosis in Patients with Hypertension

Objective

Predisposing factors for coronary atherosclerosis in hypertensive individuals are unclear. Atherosclerosis is a chronic inflammatory disease caused by lipid deposition in the blood vessels, and aldehyde dehydrogenase 2 (ALDH2) is involved in this process. The aim of this study was to assess the relationship between ALDH2 rs671 polymorphism, serum lipids, peripheral inflammation indices (pan-immune inflammation value (PIV), systemic immune inflammation index (SII), and system inflammation response index (SIRI)) and coronary atherosclerosis risk in hypertensive patients.

Methods

A total of 923 patients with hypertension (439 patients with coronary atherosclerosis, and 484 without) who were admitted to Meizhou People's Hospital between January 2019 and February 2024 were retrospectively analyzed. The relationship between ALDH2 rs671 polymorphism, serum lipid levels, and peripheral inflammation indices and the risk of coronary atherosclerosis was analyzed.

Results

There were 532 (57.6%), 337 (36.5%), and 54 (5.9%) individuals with ALDH2 rs671 G/G, G/A, and A/A genotype, respectively. The frequency of the ALDH2 rs671 G/A genotype, and the levels of TC, LDL-C, PIV, SII, and SIRI in patients with coronary atherosclerosis were higher than those in controls. Logistic analysis showed that body mass index (BMI) ≥24.0 kg/m2 (odds ratio (OR): 1.670, 95% confidence interval (CI): 1.185-2.352, p=0.003), history of smoking (OR: 2.024, 95% CI: 1.263-3.243, p=0.003), ALDH2 rs671 G/A genotype (OR: 1.821, 95% CI: 1.280-2.589, p=0.001), high TC (OR: 1.592, 95% CI: 1.021-2.485, p=0.040), high SII (OR: 2.290, 95% CI: 1.386-3.784, p=0.001), and high SIRI (OR: 1.727, 95% CI: 1.126-2.650, p=0.012) were associated with coronary atherosclerosis in patients with hypertension.

Conclusion

Overweight (BMI ≥24.0 kg/m2), history of smoking, ALDH2 rs671 G/A genotype, high TC, SII, and SIRI levels were associated risk factors for coronary atherosclerosis in patients with hypertension.

The association between abdominal obesity and depressive symptoms among Chinese adults: Evidence from national and regional communities

BACKGROUND

The association between body shape and depressive symptoms has been reported in adults. The present study aimed to investigate the association between body shape-specific abdominal obesity and depressive symptoms among multi-regional Asian adults.

METHODS

The 2011-2012 China Health and Retirement Longitudinal Study and 2022-2023 Hangzhou study were used as the discovery and validation datasets, respectively. Body shape was assessed by body mass index categories. Abdominal obesity was defined as a body shape index (ABSI) ≥ 75th centile. Depression was measured using 10-item Centre for Epidemiological Studies Depression Scale and Geriatric Depression Scale short 15-item version, respectively. General linear and multinomial logistic models were used to explore the association of ABSI, abdominal obesity with depressive scores and presence, respectively.

RESULTS

A total of 12,229 and 1210 participants were included in the discovery and validation datasets, respectively. A non-linear reverse L-shaped association was found between ABSI and depressive scores. Participants with abdominal obesity had higher depressive scores (β = 0.05, 95%CI = 0.01-0.09; and β = 0.13, 95%CI = 0.01-0.24; respectively). Stratified analyses showed that abdominal obesity was associated with higher depressive scores (β = 0.09, 95%CI = 0.00-0.17; and β = 0.25, 95%CI = 0.05-0.46; respectively) and presence (OR = 1.46, 95%CI = 1.02-2.10; and OR = 3.95, 95%CI = 1.58-9.84; respectively) in overweight adults. Furthermore, abdominal obesity was associated with depressive symptoms among overweight females, but not among males.

LIMITATION

Causal links weren't addressed because of the observational study design.

CONCLUSION

Abdominal obesity exhibited a positive association with depressive symptoms among Asian overweight adults, particularly in females. Prevention and early diagnosis of depressive symptoms should focus on overweight females.

Development and cross-validation of prediction equations for body composition in adult cancer survivors from the Korean National Health and Nutrition Examination Survey (KNHANES)

Epidemiological studies frequently use indices of adiposity related to mortality. However, no studies have validated prediction equations for body composition in adult cancer survivors. We aimed to develop and cross-validate prediction equations for body fat mass (BFM), lean body mass (LBM), trunk fat mass (TFM), and appendicular lean mass (ALM) in adult cancer survivors using sociodemographic, anthropometric, and laboratory test data. This study included adult cancer survivors from the Korean National Health and Nutrition Examination Survey 2008-2011 with complete data on Dual-energy X-ray absorptiometry (DXA) measurements. A total of 310 participants were randomly divided into development and cross-validation groups (5:5 ratio). Age, height, weight, waist circumference, serum creatinine levels, and lifestyle factors were included as independent variables The predictive equations were developed using a multiple linear regression and their predictive performances were primarily evaluated with R2 and Concordance Correlation Coefficient (CCC). The initial equations, which included age, height, weight, and waist circumference, showed different predictive abilities based on sex for BFM (total: R2 = 0.810, standard error of estimate [SEE] = 3.072 kg, CCC = 0.897; men: R2 = 0.848, SEE = 2.217 kg CCC = 0.855; women: R2 = 0.791, SEE = 2.194 kg, CCC = 0.840), LBM (total: R2 = 0.736, SEE = 3.321 kg, CCC = 0.838; men: R2 = 0.703, SEE = 2.450 kg, CCC = 0.774; women: R2 = 0.854, SEE = 2.234 kg, CCC = 0.902), TFM (total: R2 = 0.758, SEE = 1.932 kg, CCC = 0.844; men: R2 = 0.650, SEE = 1.745 kg, CCC = 0.794; women: R2 = 0.852, SEE = 1.504 kg, CCC = 0.890), and ALM (total: R2 = 0.775, SEE = 1.726 kg, CCC = 0.876; men: R2 = 0.805, SEE = 1.320 kg, CCC = 0.817; women: R2 = 0.726, SEE = 1.198 kg, CCC = 0.802). When additional factors, such as creatinine, smoking, alcohol consumption, and physically inactive were included in the initial equations the predictive performance of the equations were generally improved. The prediction equations for body composition derived from this study suggest a potential application in epidemiological investigations on adult cancer survivors.

Apolipoprotein E E3/E4 genotype is associated with an increased risk of coronary atherosclerosis in patients with hypertension

OBJECTIVE

Apolipoprotein E (APOE) gene polymorphisms were associated with coronary atherosclerosis and hypertension. However, the relationship between APOE polymorphisms and coronary atherosclerosis susceptibility in hypertensive patients is unclear. The aim of this study was to assess the relationship.

METHODS

A total of 1713 patients with hypertension who were admitted to Meizhou People's Hospital from November 2019 to August 2023 were retrospectively analyzed, including 848 patients with coronary atherosclerosis and 865 patients without coronary atherosclerosis. The rs429358 and rs7412 polymorphisms of APOE were genotyped, and relationship between APOE polymorphisms and the risk of coronary atherosclerosis in hypertensive patients were analyzed.

RESULTS

There were 10 (0.6%), 193 (11.3%), 30 (1.8%), 1234 (72.0%), 233 (13.6%), and 13 (0.8%) individuals with APOE ɛ2/ɛ2, ɛ2/ɛ3, ɛ2/ɛ4, ɛ3/ɛ3, ɛ3/ɛ4, and ɛ4/ɛ4 genotype, respectively. The frequency of APOE ɛ3/ɛ4 was higher (16.4% vs. 10.9%, p = 0.001) in the patients with coronary atherosclerosis than controls. Logistic analysis showed that body mass index (BMI) ≥ 24.0 kg/m2 (24.0 kg/m2 vs. 18.5-23.9 kg/m2, odds ratio (OR): 1.361, 95% confidence interval (CI): 1.112-1.666, p = 0.003), advanced age (≥ 65/<65, OR:1.303, 95% CI: 1.060-1.602, p = 0.012), history of smoking (OR: 1.830, 95% CI: 1.379-2.428, p < 0.001), diabetes mellitus (OR: 1.380, 95% CI: 1.119-1.702, p = 0.003), hyperlipidemia (OR: 1.773, 95% CI: 1.392-2.258, p < 0.001), and APOE ɛ3/ɛ4 genotype (ɛ3/ɛ4 vs. ɛ3/ɛ3, OR: 1.514, 95% CI: 1.133-2.024, p = 0.005) were associated with coronary atherosclerosis in hypertensive patients.

CONCLUSIONS

Overweight (BMI ≥ 24.0 kg/m2), advanced age, history of smoking, diabetes mellitus, and APOE ɛ3/ɛ4 genotype were independent risk factors for coronary atherosclerosis in hypertensive patients.

The association between metabolic syndrome and major adverse cardiac and cerebrovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Metabolic syndrome (MetS) poses an additional risk for the development of coronary artery disease and major adverse cardiac and cerebrovascular events (MACCE). In this study, we investigated the association between MetS and its components and MACCE after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The presence of MetS was calculated at baseline using the NCEP-ATP III criteria. The primary outcome was MACCE and its components were secondary outcomes. Unadjusted and adjusted Cox Regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) of the association between MetS or its components and MACCE and its components. A total of 13,459 ACS patients who underwent PCI (MetS: 7939 and non-MetS: 5520) with a mean age of 62.7 ± 11.0 years (male: 72.5%) were included and median follow-up time was 378 days. Patients with MetS had significantly higher MACCE risk (adjusted HR [aHR] 1.22, 95% CI 1.08-1.39). The only component of MACCE that exhibited a significantly higher incidence in MetS patients was myocardial infarction (aHR 1.43, 95% CI 1.15-1.76). MetS components that were significantly associated with a higher incidence of MACCE were hypertension and impaired fasting glucose. Having three MetS components did not increase MACCE (aHR 1.12, 95% CI 0.96-1.30) while having four (aHR 1.32, 95% CI 1.13-1.55) or five (aHR 1.42, 95% CI 1.15-1.75) MetS components was associated with a higher incidence of MACCE. MetS was associated with a higher risk of MACCE in ACS patients undergoing PCI. Among MACCE components, myocardial infarction was significantly higher in patients with MetS. Impaired fasting glucose and hypertension were associated with a higher risk of MACCE. Identifying these patterns can guide clinicians in choosing appropriate preventive measures.

Association Between Body Mass Index and All-Cause Mortality in a Prospective Cohort of Southern Chinese Adults Without Morbid Obesity

Objective: This prospective study examined the relationship between body mass index (BMI) and all-cause mortality in Chinese adults without morbid obesity.

Methods: We prospectively examined the relationship between BMI and all-cause mortality in 12,608 Southern Chinese adults with age ≥35 years who participated in the National Key R&D Program from 2013–2014 to 2019–2020. Cox proportional hazards models were used to examine the association between BMI and all-cause mortality.

Results: The prevalence of being underweight, normal weight, overweight and having moderate obesity was 7.36%, 55.83%, 28.51% and 8.31%, respectively. A total of 683 (5.65%) deaths occurred during a median follow-up period of 5.61 years. The Cox proportional hazards models indicated that a continuous BMI level was negatively associated with all-cause mortality [adjusted-hazard ratio (HR) per 1 kg/m² increase: 0.96, 95% CI 0.93 to 0.98, p < 0.001]. Furthermore, the HRs of all-cause mortality in the underweight, overweight and moderate obesity groups were 1.31 (1.05, 1.64), 0.89 (0.73, 1.08) and 0.64 (0.44, 0.92), respectively in the confounder model relative to the normal weight group. Survival analysis further confirmed this inverse association of the four BMI categories with mortality.

Conclusion: BMI was negatively associated with all-cause mortality in southern Chinese adults without morbid obesity. Compared to the normal weight category, adults in the moderate obesity category had lower all-cause mortality, whereas being underweight was associated with increased all-cause mortality.

Relationship of body fat and left ventricular hypertrophy with the risk of all-cause death in patients with coronary artery disease

BACKGROUND

Left ventricular hypertrophy (LVH) is prevalent in obese individuals. Besides, both of LVH and obesity is associated with subclinical LV dysfunction. The study aims to investigate the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease (CAD).

METHODS

In this retrospective cohort study, a total of 2243 patients with angiographically proven CAD were included. Body fat and LV mass were calculated using established formulas. Patients were grouped according to body fat percentage and presence or absence of LVH. Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death.

RESULTS

Of 2243 patients enrolled, 560 (25%) had a higher body fat percentage, and 1045 (46.6%) had LVH. After a median follow-up of 2.2 years, the cumulative mortality rate was 8.2% in the group with higher body fat and LVH, 2.5% in those with lower body fat and no LVH, 5.4% in those with higher body fat and no LVH, and 7.8% in those with lower body fat and LVH (log-rank P < 0.001). There was a statistically significant interaction between body fat percentage and LVH ( P interaction was 0.003). After correcting for confounding factors, patients with higher body fat and LVH had the highest risk of all-cause death (HR = 3.49, 95% CI: 1.40-8.69, P = 0.007) compared with those with lower body fat and no LVH; in contrast, patients with higher body fat and no LVH had no statistically significant difference in risk of death compared with those with lower body fat and no LVH (HR = 2.03, 95% CI: 0.70-5.92, P = 0.195).

CONCLUSION

A higher body fat percentage was associated with a different risk of all-cause death in patients with CAD, stratified by coexistence of LVH or not. Higher body fat was significantly associated with a greater risk of mortality among patients with LVH but not among those without LVH.

Body Mass Index and Mortality in Chinese Older Adults -New Evidence from a Large Prospective Cohort in China

OBJECTIVES

To comprehensively evaluate the association between BMI and death risk in people aged 65 years and over in Shenzhen, China, and suggest the optimal range of body mass index (BMI) for the older adults.

DESIGN

A prospective cohort study.

SETTING

A population-based study of elderly adults in Shenzhen, China.

PARTICIPANTS

359044 Shenzhen Healthy Ageing Research participants aged 65 and over with 4682 deaths during a mean of 1.5 years of follow-up were included in this analysis.

MEASURES

Hazard ratio of all-cause and cause specific mortality risks associated with BMI categories. The association between BMI and all-cause and cause specific mortality were independently estimated by Cox regression model.

RESULTS

Regardless of gender, BMI of 24 -29.9 kg/m2 was a protective factor for death in all ages, while BMI above 30 kg/m2 was still a protective factor for older adults under 70 years old. Regardless of age, BMI at 24-25.9 kg/m2 was associated with lower mortality in men, while BMI at 26-27.9 kg/m2 was associated with lower mortality in women. For the older adults without chronic diseases, BMI at 24-25.9 kg/m2 was also significantly associated with lower mortality. In the analysis of BMI and cause of death, we also found that BMI of 24-25.9 kg/m2 was significantly associated with the lower mortality from cardiovascular disease, cancer, chronic respiratory disease and digestive system disease in China.

CONCLUSION

BMI in the range of 24-25.9 kg/m2 may be protective for mortality in Chinese older adults. Additional more large-scale, multicenter and long-term follow-up studies are needed to confirm these findings in different populations.

Prevalence and impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome

BACKGROUND AND AIMS

Metabolic syndrome (MetS) is associated with increased incidence of diabetes and cardiovascular diseases in patients initially free from these diseases. However, its prognostic value in patients with established coronary artery diseases remains controversial. Therefore, we aimed to illustrate the prevalence and investigate the impact of MetS in patients with multivessel coronary artery disease (MVD) and acute coronary syndrome (ACS).

METHODS AND RESULTS

This was a large registry of consecutive patients with ACS referred to primary percutaneous coronary intervention (PCI) and those with MVD were eligible for this analysis. MetS was defined based on modified Adult Treatment Panel III definition. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction and stroke. A total of 2532 patients were included in the current analysis and 993 (39.2%) of them had MetS. The prevalence of MetS increased from 2010 to 2016 (p _{for trend} = 0.005). In patients over 60 years old, the prevalence of MetS decreased with aging (p _{for trend} = 0.002). Female subjects had a higher prevalence than their male counterparts (61.5% verse 32.9% and p < 0.001). Over a median follow-up of 2.3 years, MetS was not significantly associated with MACE (adjusted 95% CI from 0.92 to 1.54).

CONCLUSION

MetS was frequently observed in patients with MVD and ACS. Patients with MetS were more likely to be young and female. However, it was not an independent predictor for MACE after primary PCI in those patients.