Abstract
OBJECTIVE: To find out the severity of coronary atherosclerosis and its relationship to body structure and adiposity in severely obese people with body mass index (BMI) ≥35.0 kg/m2 and to examine the incidence and characteristic features of myocardial infarction and other fatal coronary events in this population.
DESIGN: Autopsy reports were analyzed, including data on age, height, weight, abdominal subcutaneous fat thickness, heart weight, coronary atherosclerosis, histopathology and toxicology. Myocardial collagen and arteriolar structure were examined by computerized image analysis.
SUBJECTS: Forensic autopsy cases (n=166) with a BMI ≥35.0 kg/m2 examined in 1992–1998 were collected from the files of the Department of Forensic Medicine, University of Oulu, Finland.
RESULTS: In a large number of the severely obese individuals, the coronary arteries were either lesion-free or only fatty streaks were observed (38% of men, 44% of women) and coronary thrombosis was rare (3.8% of men and 1.6% of women). Cardiac causes of death predominated, cardiomyopathy being the commonest. Myocardial infarction was the immediate cause of death in 14.4% of men and 12.9% of the women, and it was associated with increased heart size in men. Coronary atherosclerosis without any infarction had been determined as the cause of death in 8.6% of the men and 8.1% of the women. Abdominal subcutaneous fat thickness had a significant negative association with the severity of coronary atherosclerosis in the women, and a decrease in the arteriolar media/lumen ratio with increasing BMI was observed in the men.
CONCLUSIONS: A considerable number of severely obese people have only fatty streaks and no marked stenosis in their coronary arteries, even at an advanced age. The large amounts of subcutaneous adipose tissue in obese women may provide some protection against coronary lesion development, which could be an estrogen effect. Myocardial infarction in severely obese men is associated with cardiac hypertrophy. The significance of the BMI-related dilatation of the myocardial arterioles in men and its relationship to a remodelling of the epicardial arteries will require future investigations.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Kumanyika S . Searching for the association of obesity with coronary artery disease Obes Res 1995 3: 273–275.
Duflou J, Virmani R, Rabin I, Burke A, Farb A, Smialek J. Sudden death as a result of heart disease in morbid obesity . Am Heart J 1995 130: 306–313.
Warnes CA, Roberts EC . The heart in massive (more than 300 pounds or 136 kilograms) obesity: analysis of 12 patients studied at necropsy Am J Cardiol 1984 54: 1087–1091.
Kasper EK, Hruban RH, Baughman KL . Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure Am J Cardiol 1992 70: 921–924.
Alpert MA, Hashimi MW . Obesity and the heart Am J Med Sci 1993 306: 117–123.
Valensi P . Hemodynamics of massive obesity Rev Prat 1993 43: 1918–1923.
Hubert HB, Feinleib M, McNamara PM, Castelli WP . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study Circulation 1983 67: 968–977.
Manson JE, Colditz GA, Stampfer MJ, Willet WC, Rosner B, Monson RR, Speizer FE, Hennekens CH . A prospective study of obesity and risk of coronary heart disease in women New Engl J Med 1990 322: 882–889.
Björntorp P . Obesity and the risk of cardiovascular disease Ann Clin Res 1985 17: 3–9.
Tuomilehto J, Salonen JT, Marti B, Jalkanen L, Puska P, Nissinen A, Wolf E . Body weight and risk of myocardial infarction and death in the adult population of eastern Finland Br Med J 1987 295: 623–627.
Jousilahti P, Tuomilehto J, Vartiainen E, Pekkanen J, Puska P . Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland Circulation 1996 93: 1372–1379.
Kortelainen M-L, Särkioja T . Coronary atherosclerosis associated with body structure and obesity in 599 women aged between 15 and 50 y Int J Obes Relat Metab Disord 1999 23: 838–844.
Sjöström LV . Mortality of severely obese subjects Am J Clin Nutr 1992 55(Suppl 2): 516S–523S.
Kortelainen M-L, Särkioja T . Coronary atherosclerosis and myocardial hypertrophy in relation to body fat distribution in healthy women: an autopsy study on 33 violent deaths Int J Obes Relat Metab Disord 1997 21: 43–49.
Champ CS, Coghill SB . Visual aid for quick assessment of coronary artery stenosis at necropsy Clin Pathol 1989 49: 887–888.
deSimone MJ, deDivitiis O, Alderman MH . Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight J Am Coll Cardiol 1992 20: 1251–1260.
Junqueira LCU, Bignolas G, Brentani RR . Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections Histochem J 1979 11: 447–455.
Jalil JE, Doering CW, Janicki JS, Pick R, Shroff SG, Weber K . Fibrillar collagen and myocardial stiffness in the intact hypertrophied rat left ventricle Circ Res 1989 64: 1041–1050.
Brilla CG, Weber KT . Reactive and reparative myocardial fibrosis in arterial hypertension in the rat Cardiovasc Res 1992 26: 671–677.
O'Connor WN, Valle S . A combination of Verhoeff's elastic and Masson's trichrome stain for routine histology Stain Technol 1982 57: 207–210.
Schwartzkopff B, Mundhenke M, Strauer BE . Alterations of the architecture of subendocardial arterioles in patients with hypertrophic cardiomyopathy and impaired coronary vasodilator reserve: a possible cause for myocardial ischaemia J Am Coll Cardiol 1998 31: 1089–1096.
Ito N, Nitta Y, Ohtani H, Ooshima A, Isoyama S . Remodelling of microvessels by coronary hypertension or cardiac hypertrophy in rats J Mol Cell Cardiol 1994 26: 49–59.
Schwartzkopff B, Frenzel H, Dieckerhoff J, Betz P, Flasshove M, Schulte HD, Mundhenke M, Motz W, Strauer BE . Morphometric investigation of human myocardium in arterial hypertension and valvular aortic stenosis Eur Heart J 1992 13 Suppl D: 17–23.
Silver MM, Silver MD . Cardiomyopathies. In: Silver MD (ed). Cardiovascular pathology Churchill Livingstone: New York 1991 743–810.
Uemura K, Stenby NH, Vanacek R, Vihert A, Kagan A . Grading atherosclerosis in aorta and coronary arteries obtained at autopsy: application of a tested method Bull World Health Organ 1964 31: 297–320.
Baroldi G . Diseases of extramural coronary arteries. In: Silver MD (ed). Cardiovascular pathology Churchill Livingstone: New York 1991 478–563.
Zipes DP, Wellens HJJ . Sudden cardiac death Circulation 1998 98: 2334–2351.
Burke AP, Farb A, Liang You-hui, Smialek J, Virmani R . Effect of hypertension and cardiac hypertrophy on coronary artery morphology in sudden cardiac death Circulation 1996 94: 3138–3145.
Sheridan DJ, McAinsh A, O'Gorman DJ . The coronary circulation in cardiac hypertrophy J Cardiovasc Pharmacol 1993 22(Suppl 6): S18–S28.
Van der Kooy, Seidel JC . Techniques for the measurement of visceral fat: a practical guide Int J Obes Relat Metab Disord 1993 17: 187–196.
Acknowledgements
This study was supported by a grant from the Finnish Foundation for Cardiovascular Research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kortelainen, ML. Myocardial infarction and coronary pathology in severely obese people examined at autopsy. Int J Obes 26, 73–79 (2002). https://doi.org/10.1038/sj.ijo.0801852
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ijo.0801852
Keywords
This article is cited by
-
The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors
Cardiovascular Diabetology (2018)
-
An Obesity Paradox: Increased Body Mass Index Is Associated with Decreased Aortic Atherosclerosis
Current Hypertension Reports (2017)
-
Increased intrathoracic and hepatic visceral adipose tissue independently correlates with coronary artery calcification in asymptomatic patients
Journal of Nuclear Cardiology (2014)
-
Regional Heterogeneity of Functional Changes in Conduit Arteries After High‐fat Diet
Obesity (2008)