Paradoxical protective effect of central obesity in patients with suspected stable coronary artery disease.

OBJECTIVE: Increased body mass index (BMI) has been paradoxically inversely associated with the presence of angiographic coronary artery disease (CAD). Central obesity measures, considered to be more appropriate for assessing obesity-related cardiovascular risk, have been little studied in relation to the presence of CAD. The aim was to investigate the association of central obesity with the presence of angiographic CAD as well as the prognostic significance of obesity measures in CAD prediction when added to other cardiovascular risk factors. DESIGN AND METHODS: Patients with suspected stable CAD (n = 403, age 61 ± 10 years, 302 males) referred for diagnostic coronary angiography with documented anthropometric data were enrolled. RESULTS: Significant angiographic CAD was found in 51% of patients. Both BMI (OR = 0.64 per 1 SD increase, P = 0.001) and waist circumference (WC) (OR = 0.54 per 1 SD increase, P < 0.001) were inversely associated with the presence of CAD even after adjustment for cardiovascular risk factors. In subgroup analysis, BMI and WC were significantly inversely associated with the presence of CAD in males, non diabetics, patients >60 years old and patients with Framingham risk score (FRS) >20% (P < 0.01 for all). The addition of BMI or WC in FRS-based regression models improved prediction of CAD (P = 0.03 and P < 0.001 for BMI and WC respectively) without a significant difference between the two models (P = 0.08). CONCLUSIONS: Central and overall obesity were independently associated with a reduced prevalence of angiographic CAD, lending further credence to the existence of the 'obesity paradox'. Obesity measures may further improve risk discrimination for the presence of CAD when added in an established risk score such as FRS.

Increased aortic pulse wave velocity is associated with the presence of angiographic coronary artery disease in overweight and obese patients.

BACKGROUND: Increased arterial stiffness assessed by carotid-femoral pulse wave velocity (CFPWV) and central augmentation index (AIx), has been associated with a worse cardiovascular prognosis and increased prevalence of angiographic coronary artery disease (CAD). Obesity, a well-recognized cardiovascular risk factor, has been related to increased arterial stiffness, although not consistently. The aim of this work was to investigate the association of arterial stiffness indices with obesity measures in patients undergoing coronary angiography and to study any potential association of arterial stiffness with angiographic CAD in relation to obesity. METHODS: Three hundred ninety-three patients with suspected stable CAD (aged 61±10 years; n = 303 men) referred for diagnostic coronary angiography were included. Body mass index (BMI), waist circumference (WC), and traditional cardiovascular risk factors were measured. Arterial stiffness was assessed by CFPWV and AIx using applanation tonometry in all patients. RESULTS: CFPWV was not associated with obesity measures in multiple-adjusted logistic regression analysis (P > 0.05), whereas AIx was inversely associated with BMI and WC (P < 0.05 for both). Increased CFPWV was associated with CAD in overweight and obese patients (BMI ≥25kg/m(2); WC ≥94cm in men and ≥80cm in women; P < 0.05). No association of AIx with CAD was found (P > 0.05). CONCLUSIONS: Arterial stiffness indices were not consistently associated with obesity, opposite to what might have been expected. The association of increased CFPWV with the presence of angiographic CAD in patients with increased BMI or WC values warrants further research.

A series of 22 patients with adult-onset Still's disease presenting with fever of unknown origin. A difficult diagnosis?

Adult-onset Still's disease (AOSD) remains a perplexing, difficult to diagnose clinical entity, with clinical characteristics that are often broad and encountered in numerous other clinical entities. This vague clinical presentation is depicted in the commonly used diagnostic criteria, as the ones by Yamaguchi and Fautrel. The authors sought to investigate how diagnostic criteria apply in a series of 22 new cases of AOSD patients presenting with fever of unknown origin (FUO) and diagnosed at the Internal Medicine Department of Hatzikosta General Hospital of Ioannina, Greece. The aims of the study were: (1) to study the incidence of AOSD and (2) to retrospectively apply different classifications to the data of these patients in search of a more efficient way of diagnosing these patients in the future. The annual incidence of AOSD was estimated at two new cases per 10(5). The clinical manifestations of the patients are discussed, with an emphasis on specific manifestations being considered as criteria by Yamaguchi and Fautrel classifications. Four patients exhibited markedly increased serum D: -dimers, a finding of which the potential pathophysiologic implications are discussed. Serum ferritin levels have additive values, both for diagnostic and cost-reduction purposes in cases presenting as FUO; serum ferritin values are not included in any diagnostic set of criteria at present. The finding of high levels of D-dimers in AOSD needs further studies.