Obesity and age of first non-ST-segment elevation myocardial infarction

Objectives Because excess adiposity is one of the most important determinants of adipokines and inflammatory factors associated with coronary plaque rupture, we hypothesized that obesity was associated with myocardial infarction at earlier ages. Background The developing obesity pandemic of the past 50 years has gained considerable attention as a major public health threat. Methods The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) registry was a voluntary observational data collection and quality improvement initiative that began in November 2001, with retrospective data collection from January 2001 to January 2007. The CRUSADE initiative included high-risk patients with unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI). We retrospectively examined, among 189,065 patients with acute coronary syndrome (between January 2001 and September 2006) in the CRUSADE initiative, the relationship of body mass index (BMI) with patient age of first NSTEMI. Results A total of 111,847 patients with NSTEMI were included in the final analysis. There was a strong, inverse linear relationship between BMI and earlier age of first NSTEMI. The mean patient ages (+/-SD) of first NSTEMI were 74.6 +/- 14.3 years and 58.7 +/- 12.5 years for the leanest (BMI <= 18.5 kg/m(2)) and most obese (BMI >40.0 kg/m(2)) cohorts, respectively (p < 0.0001). After adjustment for baseline demographic data, cardiac risk factors, and medications, the age of first NSTEMI occurred 3.5, 6.8, 9.4, and 12.0 years earlier with ascending levels of adiposity (BMI 25.1 to 30.0, 30.1 to 35.0, 35.1 to 40.0, and >40.0 kg/m(2), respectively; referent 18.6 to 25.0 kg/m(2)) (p < 0.0001 for each estimate). Conclusions Excess adiposity is strongly related to first NSTEMI occurring prematurely.