Identifying Risk Factors in a Mostly Overweight Patient Population with Coronary Artery Disease

Abstract

Overweight/obesity is a complex multifactorial chronic disorder, and the American Heart Association (AHA) has recently classified as a modifiable risk factor for coronary heart disease (CAD). This study (1) evaluates the association between CAD in a patient population mostly overweight (MOP) and conventional and novel coronary risk factors by using univariate and multivariate logistic regression analysis and (2) seeks to find the best model by comparing univariate and multivariate logistic regression analysis algorithms, which were systematically applied to risk factors by using Hosmer-Lemeshow statistic test. In univariate analysis, there were significant associations between CAD in MOP and conventional and novel risk factors. However, the model's sensitivity, specificity, and accuracy levels were weak. In multivariate analysis, although some risk factors were not found as predictors of coronary artery disease, the model showed good fit to data and had high sensitivity, specificity, and accuracy levels. This was also confirmed by using the Hosmer-Lemeshow goodness of fit test, more specifically.

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References

Lew EA , Garfinkel L. : Variations in mortality by weight among 75,000 men and women. J Chronic Dis 32:563-576, 1979.

Garcia Palmiere MR , Costos R. , Schiffman J. , et al: Interrelationship of serum lipids with relative weight, blood glucose and physical activity . Circulation 45:829-836, 1972.

Manson JE , Willet WC , Stampfer MJ , et al: Body weight and mortality among women. N Engl J Med 333:677-685, 1995.

Garrison RJ , Castelli WP : Weight and thirty-year mortality of men in the Framingham Study. Ann Intern Med 103:1595-1607, 1985 .

Rabkin SW , Mathewson FA , Hsu PH : Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26-year observation period: The Manitoba Study. Am J Cardiol 39:452-458, 1997.

Rimm EB , Stampfer MJ , Giovannucci E. , et al: Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol 141:1117-1127, 1995.

Eckel RH , for the Obesity and Heart Disease: A statement for healthcare from the Nutrition Committee, American Heart Association. Circulation 96 :3248-3250,1997.

Eckel RH , Krauss RM , for the AHA Nutrition Committee, American Heart Association: Call to action. Obesity as a risk factor for coronary heart disease Circulation 97:2099-2101, 1998.

Calle EE , Thun MJ , Petrelli JM , et al: Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med 341:1097-1105, 1999 .

10.

Manson JE , Colditz GA , Stampfer MJ , et al: A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 322:882-889, 1990.

11.

Smith JK , Dykes R. , Douglas JE , et al: Long-term exercise and atherogenic activity of blood mononuclear cells in persons at risk of developing ischemic heart disease. JAMA 281:1722-1727, 1999.

12.

Visser M. , Bouter LM , McQuillan GM , et al: Elevated C-reactive protein levels in overweight and obese adults . JAMA 282:2131-2135, 1999 .

13.

Scarabin PY , Aillaud MF , Amouyel P. , et al: Associations of fibrinogen factor VII and PAI-I with baseline findings among 10,500 male participants in a prospective study of myocardial infarction—the PRIME Study. Prospective epidemiological study of myocardial infarction. Thromb Haemost 80:749-756, 1998.

14.

Ridker PM : Evaluating novel cardiovascular risk factors. Can we better predict heart attacks? Ann Intern Med 130:933-937, 1999.

15.

Romieu I. , Willet WC , Stampfer MJ , et al: Energy intake and other determinants of relative weight. Am J Clin Nutr 47:406-412, 1988.

16.

Wilson PW , D'Agostino RB , Levy D. , et al: Prediction of coronary heart disease using risk factor categories . Circulation 97:1837-1847, 1998 .

17.

D'Agostino RB , Russel MW , Huse DM , et al: Primary and subsequent coronary risk appraisal. New results from the Framingham study . Am Heart J 139 :272-281, 2000.

18.

Stein E. : Laboratory surrogates for anti-atherosclerotic drug development. Am J Cardiol 87(suppl) :21A-26A, 2001.

19.

Friedewald WT , Levy R. , Fredrickson DS : Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge . Clin Chem 18:499-502, 1972.

20.

Stamler J. , Vaccaro O. , Neaton JD , et al: Diabetes, other risk factors and 12 year cardiovascular mortality for men screened in the Multiple Risk Factor Interventional Trial. Diabetes Care 16:434-444, 1993.

21.

Haffner SM , Lehto S. , Ronnemaa T. , et al: Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction . N Engl J Med 339:229-234, 1998.

22.

Craig WY , Neveuex LM , Palomaki GE , et al: Lipoprotein (a) as a risk factor for ischemic heart disease: A meta analysis of prospective studies. Clin Chem 44:2301-2306, 1998.