Coronary artery disease in Iranian overweight women

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Abstract

Background

Coronary artery disease is the leading cause of mortality in Iran. This study aimed to evaluate coronary risk factors in Iranian overweight and obese women.

Methods and subjects

Of all overweight and obese women examined in the main heart clinic in Rasht city, Iran, between 2000 and 2003, those with angiographically approved coronary artery disease (n = 180) and overweight normal coronary women (n = 224) participated in this study. The subjects in both groups had body mass index above 25 kg/m2. Data on age, educational level, cigarette smoking, alcohol drinking and current drug therapy were collected using questionnaires. Total serum cholesterol, high density lipoprotein cholesterol, triglyceride, apoprotein B, apoprotein A1, lipoprotein (a), blood glucose, body weight, height, and waist circumference were measured in both groups.

Results

The findings indicated that mean age (57.3 ± 10.9 vs 40.3 ± 10.1 p < 0.0001) was significantly higher in coronary artery diseased group than normal overweight and obese subjects. Other measured risk factors including waist circumference, blood lipids and blood pressure were higher in overweight patients with coronary artery disease than overweight normal subjects. Results of logistic regression analysis showed that age (OR = 1.16, 95% CI 1.10–1.21) and diabetes (OR = 6.31, 95% CI 1.95–20.3) were the only predictors of coronary artery disease in this population of coronary obese patients. The proportion of low educated level was remarkably higher in overweight women with coronary artery disease than normal groups.

Conclusion

The findings suggested that advancing age and diabetes are independent predictors for development of coronary artery disease in this group of overweight and obese Iranian women. The high proportion of low educated people in these patients with coronary artery disease implicates an important public health message for targeted preventive measures in lower social groups.

Introduction

In Iran, coronary artery disease is the first cause of mortality and it accounts for 46% of overall mortality [1]. The rapid increase in coronary artery disease in Iran and many other developing countries in the world is associated with marked changes in life style regarding diet and physical activity over the past two decades [2], [3]. Based on the recent large population based study in Tehran, two-thirds of Iranian middle-aged women are either overweight or obese [4].

While obesity is as an important risk factor for coronary artery disease it is refractory to treatment once it is established and this may be especially true in women from a lower social class who are less concerned about thinness and dieting [5], [6], [7]. While efforts should be still focused on the prevention of overweight and obesity in the community, exploring predictors of coronary artery disease in this steadily increasing population of overweight and obese female may help to establish strategies for reducing coronary artery disease or delaying it's developing in this population. On the other hand, the available evidence suggests that the specific level of risk for coronary artery disease at a given level of obesity may be different depending on societal conditions [8]. There is, however, no information on social differences in the prevalence of coronary artery disease in Iran.

This study, therefore, aimed to compare coronary artery disease risk factors and educational levels in a group of Iranian overweight and obese women with and without coronary artery disease in Rasht city, Iran.

Section snippets

Subjects and method

A total of 853 women with symptoms suspicious to be related to heart disease was examined in the main public heart clinic in Rasht, a city in north of Iran from 2000 to 2003. Among this group of patients a number of 518 women were either overweight or obese and 114 were taking antilipid or antihypertensive medications. Data analysis included 404 overweight and obese women who were not taking either antilipid or antihypertensive medications. The women were examined clinically and underwent

Results

Characteristics of the subjects and comparison of risk factors between two groups of normal and coronary patients are given in Table 1. Mean BMI was not different between two groups indicating that the severity of obesity was the same in the two groups. These data showed that mean age, waist circumference, systolic and diastolic blood pressure, serum level of triglyceride, lipoprotein (a) and total cholesterol were higher in patients with coronary artery disease than normal women. Fig. 1 shows

Discussion

This study indicated that increasing age and diabetes are the only independent predictors of coronary artery disease in this population of overweight and obese patients while many of the other major coronary risk factors were higher in the patients with coronary artery disease than normal group. It is well known that advancing age is a major, independent risk factor for coronary artery disease [9]. However, mean age in the coronary artery diseased patients in this study is low indicating that

Acknowledgement

We would like to thank the patients who participated in this study. Guilan University of Medical Sciences financially supported this work.

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