Association between obesity grade and the age of the first acute coronary syndrome: 1 cross-sectional observational study

Background: The study evaluates how obesity grade is associated with age during the first 14 acute coronary syndrome (ACS) and examines the effect of cardiovascular (CV) risk factors 15 and the age of first ACS in patients with severe obesity. T he effect of the degree of obesity on 16 the age of first ACS may disappear in the absence of other CV risk factors 17 Methods: We enrolled consecutive patients diagnosed with first episode of ACS between 18 2014 and 2019, and categorized them by body mass indices (BMI). Independent variables 19 affecting the age of first ACS were examined by linear regression analysis. 20 Results: A total of 1005 patients (mean age, 57.5 ± 12.3 years; 19.3% female) were included. 21 Patients with ACS with severe obesity were younger than those with ACS in the grade-I 22 obesity, overweight, and normal-weight groups (52.8 ± 9.9 vs.55.3 ± 10.9, 56.8 ± 11.4, and 23 61.4 ± 4.2, respectively, p < 0.001). BMI had a strong, inverse linear relationship with earlier age of first ACS. After adjustment CV risk factors, patients with severe obesity may 25 experience first ACS sooner than those with normal-weight, overweight, and grade-I obesity 26 (–3.4, − 5.6, and –7.1 years, respectively; p < 0.001). However, males and females with severe 27 obesity without CV risk factors experienced first ACS episode 22 and 27 years later, 28 respectively. Conclusion: Patients with severe obesity experience first ACS episode 7.1 years earlier than 30 those with normal-weight. Absence of CV risk factors in people with obesity can improve the 31 potential negative effect of obesity on the ACS age.


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Obesity is a highly preventable cause of death and an independent risk factor for 36 cardiovascular diseases (CVD) [1]. Although cardiovascular (CV) events have decreased in 37 the last 2 decades, premature atherosclerotic events have increased in younger individuals [2]. 38 This phenomenon is mainly caused by the increasing prevalence of CV risk factors, such as 39 obesity, hypertension, and diabetes mellitus (DM). Furthermore, the increasing rate of   The relationship between obesity and coronary artery disease is well documented [9], 57 but studies on the relationship between obesity grade and age during the first acute coronary 58 4 syndrome (ACS) episode are few. Obesity is associated with premature presentation of acute 59 myocardial infarction (MI) [10], and obesity grade inversely correlates with age of patients at 60 first NSTEMI episode [11]. Hence, obesity reduces the age of first ACS. However, obesity 61 was considered as a single-disease group in these studies. The MUO and MHO groups were 62 not examined separately, or the possible effect of the accompanying CV risk factors on the 63 age of ACS was not clearly examined. In the current study, we aimed to determine the 64 relationship between obesity grade and the age of first ACS and to examine the effect of CV 65 risk factors on the age of first ACS in people with severe obesity.   consuming at least 1 pack per year was considered as a "current smoker."

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Psychosocial stress was determined according to patient declaration. Patients were 119 asked the following questions: "When you think about your situation before this heart attack, 120 do you describe yourself as a stressed person?" If the answer was "yes," they were also asked 121 if they had a stress risk factor, and if no, it was considered absent. The following questions 122 were asked to people who were not familiar with the concept of stress: "Do you think you  the LDL-C value was used as a continuous variable. All statistical data were analyzed by R 155 version 3.4.4, and p < 0.05 was considered to be statistically significant.  When patients were divided into STEMI and NSTEMI/USAP groups, a similar 179 relationship was found between the age at first ACS and the obesity grade. In both groups, 180 the obesity group had a lower age at first ACS than the normal-weight group ( Figure 2). The 181 severe-obesity group was likely to have the first episode of NSTEMI and STEMI 11.7 and 182 7.1 years earlier than the normal-weight group, respectively (p <.001).  (Table 2). An interaction was found between 191 "smoking and sex" and "smoking and DM;" therefore, these interaction terms were added to     The current study shows that obesity is an independent risk factor for premature ACS.  The effect of obesity on the age of patients at first ACS has been seldom studied.

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Some studies focused on the effect of obesity on STEMI, while others focused on the effect 252 of obesity on the age of patients during NSTEMI; overall, obesity was associated with ACS 253 at an earlier age in both STEMI and NSTEMI groups. However, the effect of obesity on ACS provides data for risk factors to be studied in prospective cohort studies.

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Another limitation of our study is that we did not use specific questionnaires to define 352 psychosocial stress; thus, we could not make a more detailed psychological evaluation. also create a scientific deficiency.

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In addition, the fact that the study covers a period of 5 years may cause limitations in 364 terms of standardization of laboratory results. In the laboratory reviews included in the study 365 within this time period, the kit or calculation methods remained the same.

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An important difference between our study and other similar studies was that we 367 included patients with culprit lesions in CAG, and excluded those without CAG. Moreover, 368 patients diagnosed with Type 1 MI were included in the study, and other types of AMI were 369 excluded. Thus, a more specific patient group was formed to calculate the age of the first 370 ACS due to atherosclerotic plaque rupture. In addition, patients using drugs, such as statin 371