Are Risk Factors for Coronary Artery Disease Different in Persons With and Without Obesity?

Background: Although obesity is an independent risk factor for coronary artery disease (CAD), observational studies have found that persons with obesity have a better prognosis in established CAD compared with those with a normal body weight, suggesting that the underlying risk factors might differ between the two groups. In this study, we studied risk factors for CAD in persons with and without obesity in a Middle Eastern setting where obesity is endemic. Methods: Five hundred and fifty-six patients referred for elective coronary catheterization at Prince Hamza Hospital, Amman were included in a cross-sectional study. Patients with CAD (n=353; 63.5%) were compared to patients with a normal coronary angiography (n=203; 36.5%). Associations between CAD and baseline variables were assessed in multivariate logistic regression models. Results: In persons with obesity, male sex [adjusted odds ratio (AOR)=2.62, 95% confidence interval (CI): 1.37-4.99], increasing age (45-54 years: AOR=5.00, 95% CI: 2.01-12.48; 55-64 years: AOR=3.77, 95% CI: 1.39-10.23; 65 years: AOR=13.87, 95% CI: 4.62-41.63), diabetes mellitus (AOR=2.79, 95% CI: 1.49-5.22), and smoking (AOR=2.25, 95% CI: 1.12-4.50) were strong and significant predictors of CAD. The same risk factors were identified in persons without obesity, but in addition, waist circumference (per 1cm increment: AOR=1.04, 95% CI: 1.01-1.07) was a significant predictor of CAD in this group. Conclusions: Sex, age, diabetes mellitus, and smoking predicted CAD in all patients. Waist circumference only predicted CAD in persons without obesity, suggesting that normal-weight central obesity might be an important risk factor in this setting.