Biomarker evaluation as a potential cause of gender differences in obesity paradox among patients with STEMI

•Higher risk for MACE was shown in group BMI ≤ 24.9 kg/m2 compared to BMI 25.0–29.9 kg/m2.•The study showed no association between HDL-c (p = 0.55) or LDL-c (p = 0.10) and MACE.•No gender difference between MACE and BMI could be detected (p = 0.16).

BackgroundObesity with its worldwide growing prevalence is an established cardiovascular risk factor with increased morbidity and mortality. However, the phenomenon, that mild to moderate obesity seems to represent a protective effect on diseases has been termed the “obesity paradox”.MethodsWe retrospectively assessed 529 patients (72.6% male, mean age 59.7 ± 12.7 years) admitted with ST-elevation myocardial infarction (STEMI). The female and male study populations were separated into four body mass index (BMI) groups: ≤ 24.9 kg/m2, 25.0–29.9 kg/m2, 30.0–34.9 kg/m2 and ≥ 35.0 kg/m2. Blood samples of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were analyzed.ResultsWith increasing BMI group the rate of major adverse cardiac events (MACE) decreased in all patients (test for trend p = 0.041). No gender difference between MACE and BMI could be noticed (p = 0.16). A higher risk for MACE was indicated in group BMI ≤ 18.5 kg/m2 in comparison to group BMI 25.0–29.9 kg/m2 (OR: 7.93; 95% CI: 1.75–35.89; p = 0.0091), whereas group BMI 30.0–34.9 kg/m2 was significant associated with a lower risk in comparison to group BMI 25.0–29.9 kg/m2 (OR: 0.65; 95% CI: 0.21–1.96; p = 0.044). An association between HDL-c (p = 0.55) or LDL-c (p = 0.10) and MACE could not be detected.ConclusionThe study demonstrates that patients with STEMI and a BMI of 30.0–34.9 kg/m2 have a decreased risk for MACE compared to patients with normal BMI. No gender related differences were indicated. An association between MACE and lipoproteins could not be detected.