Body Mass Index (BMI) and Its Influence on the Cardiovascular and Operative Risk Profile in Coronary Artery Bypass Grafting Patients: Impact of Inflammation and Leptin

Abstract

Background. Obesity is related to coronary artery disease (CAD) and worse outcomes in coronary artery bypass graft (CABG) patients. Adipose tissue itself is an endocrine organ that secretes many humoral mediators, such as adipokines, which can induce or reduce inflammation and oxidative stress. Objectives. We investigate the relationship between the body mass index (BMI), inflammation, and oxidative stress by measuring serum levels of leptin, interleukin-6, and 3-nitrotyrosine in CABG patients and correlate their levels to the cardiovascular and operative risk profiles. Methods and Results. 45 men (<75 years) with a median BMI of 29 (21-51) kg/m2, who were diagnosed with CAD and scheduled for elective CABG, were included after applying the following exclusion criteria: prior myocardial infarction, reoperation, female gender, and smoking. Patients’ blood samples were taken preoperatively. Several markers were measured. We found significant correlations between leptin and BMI p<0.0001 as well as between leptin and 3-nitrotyrosine p=0.006. Interleukin-6 was correlated with C-reactive protein p<0.0001 and with the incidence of insulin-dependent diabetes mellitus p=0.036, arterial hypertension p=0.044, reduced left ventricular function p=0.003, and severe coronary calcification p=0.015. It was also associated with significantly longer extracorporeal bypass time p=0.009. Postoperative deep sternal wound infections could be predicted by a higher BMI p=0.003 and leptin level p=0.001. Conclusions. There seems to be a correlation between inflammatory processes and cardiovascular morbidity in our cohort. Further, the incidence of deep sternal wound infections is related to a higher BMI and leptin serum level.

Influence of cardiometabolic comorbidities on myocardial function, infarction, and cardioprotection: Role of cardiac redox signaling

“…BMI was directly correlated with several oxidative stress parameters, positively with p47phox expression and hydroethidium oxidation, but negatively correlated with endothelial nitric oxide synthase (eNOS) phosphorylation and dihydrofolate reductase expression in patients undergoing coronary artery bypass graft surgery [34]. In patients with IHD, BMI also correlated with leptin levels and oxidative stress markers, with an impact on cardiovascular and operative risk profiles [35]. The coexistence of hypercholesterolemia and obesity in children caused additive increase of 8-isoprostanes and soluble nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) 2-derived peptide (sNox2-dp, a marker of NOX2 activation) and additive impairment of endothelial function measured by flow-mediated dilation (FMD) [36].…”

Association of Dietary Inflammatory Index (DII) and Depressive Disorders

“… 92 Withal, adipose tissue itself is an endocrine organ that can secrete a variety of body fluid mediators, such as adipokines, which can induce or reduce inflammation and oxidative stress. 93 Some studies have provided evidence that rodent models have demonstrated that fat inflammation pathways play an important role in diet and obesity-related metabolic disorders, and mRNA microarrays and secretion profiles of human adipose tissue and fat cells have identified similar inflammatory pathways in the obesity Inflammation pathway activated by endotoxin. 94 …”

The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery

“…One explanation for this paradox is that patients with higher BMI may have a lower postoperative bleeding volume and transfusion rate; thus, such patients may save blood products during on-pump CABG factor that contributes to higher survival rates (14). On the other hand, sternal wound infections are more prevalent in obese patients and prior studies have shown increased morbidity and mortality rates in obese patients (15)(16)(17).…”