1. Longer duration of overall obesity and abdominal obesity were associated with higher degree of coronary artery calcification.
2. Delaying the onset of obesity in young adults may lower their risk of developing coronary artery disease in middle age.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Coronary artery calcification (CAC) is a known risk factor for coronary heart disease events such as myocardial infarctions. While CAC does take time to develop, we are aware of its many risk factors such as obesity, smoking, elevated blood pressure, and abnormal cholesterol levels. Because few studies have focused on the duration of obesity, this study set out to determine whether duration of overall obesity and abdominal obesity could serve as independent risk factors for CAC. Indeed, 20 years of overall obesity and abdominal obesity were found to be independently associated with presence and progression of CAC, increasing risk as much as 7%. It was found that participants with the longest duration of overall obesity and abdominal obesity were most likely to develop CAC. These finding are particularly important due to our county’s rising rates of childhood obesity. Strengths of this study include the large sample size, a multicenter design, and a diverse study population. While a well-designed and meticulous study, it is hindered in part by the use of BMI and the relatively long intervals at which patients were tested. While routinely used to monitor weight gain/loss, BMI measurements have been known to be fraught with errors, one being not accounting for muscle mass in the calculation.
In-Depth [prospective cohort]: This study followed 3,275 non-obese white and black adults ages 18-30 for 25 years. Participants were drawn from the Coronary Artery Risk Development in Young Adults multicenter study. They were recruited from four cities: Birmingham, Chicago, Minneapolis, and Oakland. Participants were tested for waist circumference and BMI at 2,5,10,15,20, and 25 years and CAC was measured by computerized tomography at the 15, 20, 25 year follow up visits. It was found that 38.2% of participants with overall obesity and 39.3% of participants with abdominal obesity developed CAC over the course of 20 years compared with 24.9% and 24.7% of those who never developed overall obesity or abdominal obesity. The hazard ratio for CAC with each additional year of overall obesity or abdominal obesity was shown to be 1.02 (95% CI, 1.01-1.03) and 1.03 (95%CI, 1.02-1.05) respectively. Longer duration of obesity was also associated with higher blood pressure, glucose, C-reactive peptide, and triglycerides.
By John Prendergass and Brittany Hasty
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