Decreasing incidence of coronary heart disease in extreme obesity (BMI≥40)-A single centre experience.

Abstract Aim The aim of our comprehensive single centre analysis was to evaluate the incidence of coronary heart disease (CHD) in extremely obese patients. Methods and results Between 2005 and 2015 we investigated retrospectively 23,359 patients undergoing cardiac catheterisation in our institution. Patients were divided in six weight classes according to World Health Organization (WHO) criteria [1] (WHO, 2000). Cardiovascular risk factors, comorbidities, CCS stadium [2] (Cox and Naylor, 1992) and NYHA functional class [3] (The Criteria Committee of the New York Heart Association, 1994) were retrieved from electronic patient records. Using multivariable analysis the odds ratio for the target variable CHD with presence of >50% angiographic stenosis was ≥1 with regard to age (OR 1.049, 95% CI 1.045–1.052), male sex (OR 2.507, 95% CI 2.329–2.699), cardiovascular risk factors, atherosclerosis (OR 1.651, 95% CI 1.498–1.820), and presence of angina (OR 4.408, 95% CI 3.892–4.993). NYHA functional class I–IV, absence of angina (OR 0.818, 95% CI 0.729–0.918), and BMI≥40 (OR 0.592, 95% CI 0.494–0.709) resulted in an odds ratio of ≤1. Underweight patients had a higher (5.3%) and overweight (1.2%) and obese patients (class I 0.9% and II 1.1%) a slightly lower all-cause in-hospital mortality compared to extremely obese patients (1.6%). Conclusion Severely obese patients treated in our hospital surprisingly showed a decreased incidence of CHD (46.1% in normal weight and 38.6% in extremely obese patients) while comorbidities increased CHD as expected. Although CHD burden was lower, obesity and associated comorbidities resulted in higher all-cause—in-hospital mortality.