Association Between Body Mass Index and Age of Presentation With Symptomatic Coronary Artery Disease

Background: Obesity is increasingly recognized as an important risk factor for coronary artery disease (CAD). Hypothesis: Patients with increased body mass index (BMI) present at a younger age with symptomatic CAD. Methods: We analyzed data on 2137 consecutive patients admitted for treatment of CAD proven on angiography from 2010 to 2013, excluding those with prior coronary intervention or bypass surgery. Results: Mean age was 64.1 ± 12.4 years; 75% were male; 43.6% were overweight (BMI 25–29.9 kg/m²) and 31.6% were obese (BMI ≥30 kg/m²). Patients with BMI ≥25 kg/m² compared with <25 kg/m² were more likely to have diabetes (24.5% vs 13.6%), hypertension (56.2% vs 45.5%), and hyperlipidemia (42.4% vs 31.6%; P < 0.0001 for all). On multivariate analysis adjusted for sex and cardiovascular risk factors, patients in higher BMI categories had lower mean age in a linear and stepwise fashion compared with those with normal BMI (P < 0.0001). For example, compared with patients with normal BMI, those with BMI of 35 to 39.9 kg/m² were on average 9.2 years younger (P < 0.0001). Multivariate analysis examining the interaction between sex and BMI produced similar results for effect of BMI on age of presentation (P = 0.97 for interaction). Conclusions: After multivariate adjustment, patients with increased BMI presented at an earlier age with symptomatic CAD compared with patients with normal BMI. Primary prevention efforts in those with increased BMI to reduce risk-factor burden, including evidence-based treatments for weight reduction, promise to reduce risk or delay onset of CAD.