Differences in the number of stented coronary arteries based on the seven traditional obesity parameters among patients with coronary artery diseases undergoing cardiac catheterization
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Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, JORDAN
Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, P. O. Box 330127, Zarqa, 13133, JORDAN
Publication date: 2022-07-03
Electron J Gen Med 2022;19(5):em391
Obesity has been correlated with certain sociodemographic and health variables of patients with coronary artery diseases (CADs). There are seven traditional obesity parameters, which have been used to measure obesity (body mass index [BMI], waist-to-height ratio [WHtR], waist-hip ratio [WHR], body adiposity index [BAI], body shape index [BSI], waist circumference [WC], and hip circumference [HC]). This study aimed to describe the differences in the number of stented coronary arteries based on the aforementioned seven traditional obesity parameters among patients with CADs undergoing cardiac catheterization.

A descriptive cross-sectional study was conducted among 220 hospitalized patients with CADs undergoing a cardiac catheterization. Data were analyzed using frequencies, percentages, bar graphs presentation, and receiver operating characteristics.

Receiver operating characteristic curve indicated that the best cut off point of WC is 95 cm in predicting number of stented coronary arteries with a sensitivity of 76% and a specificity of 68%. BMI had a high sensitivity with the number of stented coronary arteries. The sensitivity values of parameters ranged from 0.45 to 0.92 and the specificity values ranged from 0.25 to 0.68. All traditional obesity parameters except the BSI had a good ability to be highly associated with the number of stented coronary arteries.

Healthcare providers, including nurses, should pay a high attention to these obesity parameters while caring of patients with CAD undergoing cardiac catheterization.

World Health Organization (WHO). Obesity and overweight. 2021. Available at: https://www.who.int/news-room/... (Accessed: 11 May 2022).
Ades PA, Savage PD. Obesity in coronary heart disease: An unaddressed behavioral risk factor. Prev Med. 2017;104:117-9. https://doi.org/10.1016/j.ypme... PMid:28414064 PMCid:PMC5640469.
Liu J, Tse LA, Liu Z, et al. Predictive values of anthropometric measurements for cardiometabolic risk factors and cardiovascular diseases among 44048 Chinese. J Am Heart Assoc. 2019;8(16):e010870. https://doi.org/10.1161/JAHA.1... PMid:31394972 PMCid:PMC6759887‏.
Gregory AB, Lester KK, Gregory DM, et al. The relationship between body mass index and the severity of coronary artery disease in patients referred for coronary angiography. Cardiol Res Pract. 2017;5481671. https://doi.org/10.1155/2017/5... PMid:28512592 PMCid:PMC5420422.
Jelavic MM, Babic Z, Pintaric H. The importance of two metabolic syndrome diagnostic criteria and body fat distribution in predicting clinical severity and prognosis of acute myocardial infarction. Arch Med Sci. 2017;13(4):795-806. https://doi.org/10.5114/aoms.2... PMid:28721147 PMCid:PMC5510506.
Coutinho T, Goel K, Corrêa de Sá D, et al. Central obesity and survival in subjects with coronary artery disease: A systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol. 2011;57(19):1877-86. https://doi.org/10.1016/j.jacc... PMid:21545944.
Qureshi SA, Straiton M, Gele AA. Associations of socio-demographic factors with adiposity among immigrants in Norway: A secondary data analysis. BMC Public Health. 2020;20(1):1-10. https://doi.org/10.1186/s12889... PMid:32448125 PMCid:PMC7247236.
Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med. 2017;5(7):161. https://doi.org/10.21037/atm.2... PMid:28480197 PMCid:PMC5401682.
Adisasmita AC. Association between physical activity and obesity with diabetes mellitus in Indonesia. Int J Caring Sci. 2019;12(3):1703-9.
Avila C, Holloway AC, Hahn MK, et al. An overview of links between obesity and mental health. Curr Obes Rep. 2015;4(3):303-10. https://doi.org/10.1007/s13679... PMid:26627487.
Duncan MJ, Vandelanotte C, Caperchione C, Hanley C, Mummery WK. Temporal trends in and relationships between screen time, physical activity, overweight and obesity. BMC Public Health. 2012;12(1):1-9. https://doi.org/10.1186/1471-2... PMid:23216917 PMCid:PMC3541208.
Misra A, Jayawardena R, Anoop S. Obesity in South Asia: Phenotype, morbidities, and mitigation. Curr Obes Rep. 2019;8(1):43-52. https://doi.org/10.1007/s13679... PMid:30729382.
Ohlsson B, Manjer J. Sociodemographic and lifestyle factors in relation to overweight defined by BMI and “normal-weight obesity”. J Obes. 2020; 2070297. https://doi.org/10.1155/2020/2... PMid:31998533 PMCid:PMC6969981.
Ford ND, Patel SA, Narayan KV. Obesity in low-and middle-income countries: Burden, drivers, and emerging challenges. Annu Rev Public Health. 2017;38:145-64. https://doi.org/10.1146/annure... PMid:28068485.
Goryakin Y, Lobstein T, James WPT, Suhrcke M. The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries. Soc Sci Med. 2015;133:67-76. https://doi.org/10.1016/j.socs... PMid:25841097 PMCid:PMC4416723.
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766-81. https://doi.org/10.1016/S0140-....
Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3-21. https://doi.org/10.1111/j.1753... PMid:22221213 PMCid:PMC3257829.
Ghazali SM, Seman Z, Cheong KC, et al. Sociodemographic factors associated with multiple cardiovascular risk factors among Malaysian adults. BMC Public Health. 2015;15(1):1-8. https://doi.org/10.1186/s12889... PMid:25636327 PMCid:PMC4319230.
Hajar R. Risk factors for coronary artery disease: Historical perspectives. Heart Views. 2017;18(3):109. https://doi.org/10.4103/HEARTV... PMid:29184622 PMCid:PMC5686931.
Jahangir E, De Schutter A, Lavie CJ. The relationship between obesity and coronary artery disease. Transl Res. 2014;164(4):336-44. https://doi.org/10.1016/j.trsl... PMid:24726461.
Chigbu CO, Parhofer KG, Aniebue UU, Berger U. Prevalence and sociodemographic determinants of adult obesity: A large representative household survey in a resource-constrained African setting with double burden of undernutrition and overnutrition. J Epidemiol Community Health. 2018;72(8):702-7. https://doi.org/10.1136/jech-2... PMid:29599385.
Tarastchuk JCE, Guerios EE, Bueno RRL, et al. Obesity and coronary intervention: Should we continue to use body mass index as a risk factor? Arq Bras Cardiol. 2008;90(5):284-9. https://doi.org/10.1590/S0066-... PMid:18516395.
Smith TJ, Marriott BP, Dotson L, et al. Overweight and obesity in military personnel: Sociodemographic predictors. Obes. 2012;20(7):1534-8. https://doi.org/10.1038/oby.20... PMid:22314620.
Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors from NCD risk factor collaboration. Circ Cardiovasc Qual Outcomes. 2019;12(6):e005375. https://doi.org/10.1161/CIRCOU... PMid:31163980 PMCid:PMC6613716.
Lee DS, Chiu M, Manuel DG, et al. Trends in risk factors for cardiovascular disease in Canada: Temporal, socio-demographic and geographic factors. CMAJ. 2009;181(3-4):E55-E66. https://doi.org/10.1503/cmaj.0... PMid:19620271 PMCid:PMC2717674.
Fan H, Li X, Zheng L, et al. Abdominal obesity is strongly associated with cardiovascular disease and its risk factors in elderly and very elderly community-dwelling Chinese. Sci Rep. 2016;6(1):1-9. https://doi.org/10.1038/srep21... PMid:26882876 PMCid:PMC4756331.
Weir CB, Jan A. BMI classification percentile and cut off points. Treasure Island, FL, USA: StatPearls Publishing; 2022.
Cai L, Liu A, Zhang Y, Wang P. Waist-to-height ratio and cardiovascular risk factors among Chinese adults in Beijing. PloS One. 2013;8(7):e69298. https://doi.org/10.1371/journa... PMid:23874938 PMCid:PMC3709905.
Ge W, Parvez F, Wu F, et al. Association between anthropometric measures of obesity and subclinical atherosclerosis in Bangladesh. Atherosclerosis. 2014;232(1):234-41. https://doi.org/10.1016/j.athe... PMid:24401245 PMCid:PMC3888510.
Guasch-Ferre M, Bulló M, Martínez-González MÁ, et al. Waist-to-height ratio and cardiovascular risk factors in elderly individuals at high cardiovascular risk. PLoS One. 2012;7(8):e43275. https://doi.org/10.1371/journa... PMid:22905246 PMCid:PMC3419167.
Cornier MA, Després JP, Davis N, et al. Assessing adiposity: A scientific statement from the American Heart Association. Circulation. 2011;124(18):1996-2019. https://doi.org/10.1161/CIR.0b... PMid:21947291.
Komatsu T, Fujihara K, Yamada MH, et al. 449-P: Impact of body mass index (BMI) and waist circumference (WC) on coronary artery disease (CAD) in Japanese with and without diabetes mellitus (DM). Diabetes. 2020;9(Supplement_1):449-P. https://doi.org/10.2337/db20-4....
Schneider HJ, Klotsche J, Silber S, Stalla GK, Wittchen HU. Measuring abdominal obesity: Effects of height on distribution of cardiometabolic risk factors risk using waist circumference and waist-to-height ratio. Diabetes Care. 2011;34(1):e7. https://doi.org/10.2337/dc10-1... PMid:21193616.
Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis. Obes Rev. 2012;13(3):275-86. https://doi.org/10.1111/j.1467... PMid:22106927.
Li WC, Chen IC, Chang YC, et al. Waist-to-height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults. Eur J Nutr. 2013;52(1):57-65. https://doi.org/10.1007/s00394... PMid:22160169 PMCid:PMC3549404.
Tee JYH, Gan WY, Lim PY. Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: A cross-sectional study. BMJ Open. 2020;10(1):e032874. https://doi.org/10.1136/bmjope... PMid:31932391 PMCid:PMC7044891.
Johnson W, Chumlea WC, Czerwinski SA, Demerath EW. Concordance of the recently published body adiposity index with measured body fat percent in European-American adults. Obesity. 2012;20(4):900-3. https://doi.org/10.1038/oby.20... PMid:22095112 PMCid:PMC3988697.
Lichtash CT, Cui J, Guo X, et al. Body adiposity index versus body mass index and other anthropometric traits as correlates of cardiometabolic risk factors. PloS One. 2013;8(6):e65954. https://doi.org/10.1371/journa... PMid:23776578 PMCid:PMC3679008.
Ziari M, Farzaneh Hesari A. The comparison of a body shape index and body roundness index and association with physical activity and anthropometric indices in healthy middleage and elderly women and with cardiovascular diseases. JMUS. 2021;27(6):778-86.
Bennasar-Veny M, Lopez-Gonzalez AA, Tauler P, et al. Body adiposity index and cardiovascular health risk factors in Caucasians: A comparison with the body mass index and others. PloS One. 2013;8(5):e63999. https://doi.org/10.1371/journa... PMid:23734182 PMCid:PMC3667028.
Oboh HA, Adedeji AA. Correlation of waist-hip-ratio and waist-height-ratio to cardiovascular risks factors in a Nigerian population. Nig Q J Hosp Med. 2011;21(1):16-24.
Vikram NK, Latifi AN, MisraA, et al. Waist-to-height ratio compared to standard obesity measures as predictor of cardiometabolic risk factors in Asian Indians in North India. Metab Syndr Relat Disord. 2016;14(10):492-9. https://doi.org/10.1089/met.20... PMid:27740885‏.
Lee C, Huxley R, Wildman R, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: A meta-analysis, J Clin Epidemiol. 2008;61(7):646-53. https://doi.org/10.1016/j.jcli... PMid:18359190.
Shen S, Lu Y, Qi H, et al. Waist-to-height ratio is an effective indicator for comprehensive cardiovascular health. Sci Rep. 2017;7(1):1-7. https://doi.org/10.1038/srep43... PMid:28220844 PMCid:PMC5318865.
Song SW, Kim JA, Kang SG, Yum KS. Waist-to-height ratio (WHtR) and coronary artery calcification. J Bone. 2016;5. https://doi.org/10.1530/boneab....
Oh HG, Nallamshetty S, Rhee EJ. Increased risk of progression of coronary artery calcification in male subjects with high baseline waist-to-height ratio: The Kangbuk Samsung health study. Diabetes Metab J. 2016;40(1):54-61.https://doi.org/10.4093/dmj.20... PMid:26912156 PMCid:PMC4768051.
Dimitriadis K, Tsioufis C, Mazaraki A, et al. Waist circumference compared with other obesity parameters as determinants of coronary artery disease in essential hypertension: A 6-year follow-up study. Hypertens Res. 2016;39(6):475-9. https://doi.org/10.1038/hr.201... PMid:26865004.
Yalcin G, Ozsoy E, Karabag T. The relationship of body composition indices with the significance, extension and severity of coronary artery disease. Nutr Metab Cardiovasc Dis. 2020;30(12):2279-85. https://doi.org/10.1016/j.nume... PMid:32928627.
Kang WY, Jeong MH, Ahn YK, et al. Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Cardiol. 2010;55(1):84-91. https://doi.org/10.1016/j.jjcc... PMid:20122553.
Ortega FB, Sui X, Lavie CJ, Blair SN. Body mass index, the most widely used but also widely criticized index: Would a criterion standard measure of total body fat be a better predictor of cardiovascular disease mortality? Mayo Clin Proc. 2016;91(4):443-55. https://doi.org/10.1016/j.mayo... PMid:26948431 PMCid:PMC4821662.
Krakauer NY, Krakauer JC. A new body shape index predicts mortality hazard independently of body mass index. PloS One. 2012;7(7):e39504. https://doi.org/10.1371/journa... PMid:22815707 PMCid:PMC3399847.
Maessen MF, Eijsvogels TM, Verheggen RJ, et al. Entering a new era of body indices: The feasibility of a body shape index and body roundness index to identify cardiovascular health status. PloS One. 2014;9(9):e107212. https://doi.org/10.1371/journa... PMid:25229394 PMCid:PMC4167703.
Wang F, Chen Y, Chang Y, Sun G, Sun Y. New anthropometric indices or old ones: Which perform better in estimating cardiovascular risks in Chinese adults. BMC Cardiovasc Disord. 2018;18(1):1-7. https://doi.org/10.1186/s12872... PMid:29378513 PMCid:PMC5789564.
Parsa AFZ, Jahanshahi B. Is the relationship of body mass index to severity of coronary artery disease different from that of waist-to-hip ratio and severity of coronary artery disease? Paradoxical findings: Cardiovascular topic. Cardiovasc J Afr. 2015;26(1):13-6. https://doi.org/10.5830/CVJA-2... PMid:25784312 PMCid:PMC4814759.
Sabah K, Nurus M, Chowdhury AW, et al. Body mass index and waist/height ratio for prediction of severity of coronary artery disease. BMC Res Notes. 2014;7(1):1-7. https://doi.org/10.1186/1756-0... PMid:24742250 PMCid:PMC4000139.
Rashiti P, Behluli I, Bytyqi AR. Assessment of the correlation between severity of coronary artery disease and waist-hip ratio. Maced J Med Sci. 2017;5(7):929. https://doi.org/10.3889/oamjms... PMCid:PMC5771297.
Zhu S, Heshka S, Wang Z, et al. Combination of BMI and waist circumference for identifying cardiovascular risk factors in Whites. Obes Res. 2004;12(4):633-45. https://doi.org/10.1038/oby.20... PMid:15090631.