Insulin Resistance, Body Mass Index and Coronary Atherosclerotic Stenosis in Obese Adults

Abstract Background: Obesity is associated with an increased risk of all-cause mortality. Mortality related to excess body weight occurs mostly due to coronary artery disease(CAD). This study is to observe the prevalence of coronary atherosclerotic stenosis in obese young-middle adults and outcomes of coronary stenosis in patients with obesity after metabolic surgery. Methods: Patients with obesity undergoing metabolic surgery were included from December 2015 to June 2017.Coronary computed tomography angiography(CTA) was examined preoperatively. Patients were divided into the stenosis group and the non-stenosis group and differences in clinical indicators and Homeostasis model assessment insulin resistance(HOMA-IR)were compared between the two groups. After metabolic surgery, the clinical indicators and severity of coronary stenosis were compared with those before metabolic surgery. Results: Among 217 consecutive obese patients with a mean body mass index(BMI) of 37.92±6.14kg/m 2 , 58(26.72%) patients were diagnosed with coronary atherosclerotic stenosis. Compared with the non-stenosis group, patients in the stenosis group had a more elder age, higher rates of male, smoking, hypertension and type 2 diabetes mellitus(T2DM), and higher levels of glycated haemoglobin(HbA1C),fasting blood glucose(FBG),fasting C-peptide and HOMA-IR( P <0.05). While there was no significant difference in BMI, waist circumstance(WC), serum lipid levels ( P＞ 0.05). The multivariate binomial logistic regression analysis showed that the age(β=0.070, OR=1.073, 95% CI 1.028-1.120, P <0.001),smoking(β=1.371, OR=3.941, 95% CI 1.257-12.357, P =0.019), and HOMA-IR(β=0.040, OR=1.041, 95% CI 1.000-1.083, P =0.047) were independent risk factors of coronary stenosis. After metabolic surgery, coronary stenosis relieved in 11/19 cases (57.89%), in which 9 cases got complete remission; coronary stenosis was aggravated in one case and remained the same in another one case. Conclusions: HOMA-IR, as well as age and smoking, is an independent risk factor for CAD in obese patients. Metabolic surgery is possibly helpful to reverse mild to moderate coronary atherosclerotic stenosis in patients with obesity.