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Unexpected Relationship Between Obesity and the Risk of Vascular Disease
Caron Rockman, MD, Yu Guo, BS, Glenn Jacobowitz, MD, Thomas Maldonado, MD, Mark Adelman, MD, Jeffrey Berger, MD.
New York University Medical Center, New York, NY, USA.
Objectives: Obesity is a risk factor for coronary artery disease. The relationship between obesity and peripheral vascular disease is not well-delineated. Our objective was to analyze the relationship between BMI and peripheral arterial disease (PAD), carotid artery stenosis (CS), and AAA in a large patient cohort.
Methods: Subjects (N=3,588,946) who underwent voluntary vascular screening examinations were utilized. BMI was calculated from height and weight. PAD was defined as an ABI ≤ 0.9; CS as stenosis ≥ 50%; and AAA with aortic diameter ≥ 3 cm. Comorbidities were self-reported.
Results: In univariate analysis among males, there was no consistent relationship between increasing BMI and either AAA or CS; the prevalence of PAD in males appeared to increase significantly only when the BMI was > 45. Additionally, a low BMI of < 20.1 in men was associated with a marked increase in PAD as compared to males with normal BMI’s. In univariate analysis among females, there was similarly no consistent relationship between increasing BMI and either AAA or CS; however, the prevalence of PAD among women appeared to increase significantly when the BMI was > 35. Similar to males, a low BMI of < 20.1 was associated with an increase in the rates of PAD and CS as compared to females with normal BMI’s. In multivariate analysis using a definition of obesity as a BMI ≥ 30, obesity appeared to be mildly protective against the development of AAA and CS in both males and females, and against the development of PAD in men. Obesity was only demonstrable as an independent risk factor for PAD in women, with an Odds Ratio of 1.067 (95% Confidence Interval 1.051 - 1.084).
Conclusions: Mild to moderate obesity does not appear to represent a significant risk factor for either AAA or CS, and may be mildly protective. Moderate to severe obesity does appear to be associated with PAD in both sexes, particularly in women, but this was only found to be significant in multivariate analysis in females. A low BMI appears to be associated with an increased risk of PAD in both sexes, and CS in women.
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