Correlation between Body Mass Index and Atherosclerosis in Coronary Arteries and Aorta: A Retrospective Autopsy Study.
Adrienne C Jordan, Jaclyn F Hechtman, Irini A Scordi-Bello. The Mount Sinai Medical Center, New York, NY
Background: Obesity has been considered a risk factor for coronary artery disease and mortality in men in large prospective studies. In those studies, “abdominal type” fat distribution was considered an important risk factor; however, the mortality data used was from death certificates and not autopsy data. The purpose of this retrospective autopsy study was to determine if body mass index (BMI) alone is predictive of coronary atherosclerosis (CA) and aortic atherosclerosis (AA).
Design: We retrospectively assessed CA and AA following post-mortem exam of 61 patients. Patient age, race, weight, and medical history were obtained from the medical record. Patient height, heart weight, and subcutaneous fat thickness were obtained from the autopsy report. Two pathologists examined the left anterior descending, circumflex and right coronary arteries and the thoracic, abdominal and infrarenal aorta. Atherosclerosis was graded as: 0 = none, 1 = mild (< 25% coronary stenosis; rare fatty streaks or fibrous plaques in the aorta), 2 = moderate (25-70% coronary stenosis; numerous fatty streaks, fibrous plaques or calcified lesions in the aorta) and 3 = severe (> 70% coronary stenosis; numerous/large calcified lesions or complicated, ulcerated lesions in the aorta). The scores of the three coronary arteries were added to give a possible total score of 0-9. The scores of the three segments of aorta were added to give a possible total score of 0-9.
Results: Sixty-one adult cases were examined. The age range was 20-97 years; 45.9% male and 54.1% female; 68.9% BMI < 30 kg/m2 and 31.1% BMI >= 30 kg/m2. Regression analysis showed a positive correlation between BMI and heart weight (p < 0.005) and between BMI and subcutaneous fat thickness (p < 0.005). There was no correlation between BMI and total CA (p = .235). In patients with BMI < 30, 57.1% had mild, 28.6% had moderate and 14% had severe total CA while in the obese group with BMI >= 30, 68.4% had mild, 21.1% had moderate and 10% had severe total CA. There was no correlation between BMI and thoracic, abdominal, infrarenal or total AA. In fact, of thoracic aortas with no atherosclerosis, 40% were non-obese and 60% were obese while none of those with severe atherosclerosis were obese (0%) and 100% were non-obese. There was a positive correlation between total CA and total AA, independent of BMI (p<0.005).
Conclusions: Our study suggests that obesity in and of itself is not predictive of pathologic coronary and/or aortic atherosclerosis and confirms that atherosclerosis is a complex systemic disease affected by many variables.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 1, Monday Morning