Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Obesity is associated with impaired coronary collateral vessel development

International Journal of Obesity volume 27, pages 1541–1545 (2003)Cite this article

Abstract

BACKGROUND: Chronic myocardial ischaemia due to coronary artery stenosis or occlusion has been shown to increase the growth of coronary collateral circulation. Collateralization leads to increased oxygen delivery to the area at risk and hence may reduce ischaemia, prevent infarction and preserve contractile function. However, there is considerable variation among patient subsets in terms of the presence or degree of collateralization. We aimed to evaluate the relationship between obesity and co-ronary collateral development in patients with ischaemic heart disease.

METHODS AND RESULTS: In all, 215 patients (mean age, 57.8±8.9 y) with body mass index (BMI)≥30 kg/m2 were enrolled into our study. A total of 90 age- and sex-matched patients (mean age, 58.7±10 y) with BMI<25 kg/m2 and significant coronary artery disease were selected as a control group. The mean age and distribution of risk factors for coronary heart disease were not significantly different between two groups other than poorer HDL cholesterol and triglyceride profile in obese patients. The mean BMI was significantly higher in the patient group (33.3±2.4 vs 22.8±1.7, P<0.001). The mean number of diseased vessels and maximum lesion severity were not significantly different between the two groups. The mean Rentrop collateral score of the patient group was significantly worse than the control group (1.08±0.68 vs 2.10±0.72, P<0.001).

CONCLUSIONS: Our findings suggest that collateral vessel development is poorer in obese patients (defined as BMI≥30 kg/m2) with ischemic heart disease compared to normal range BMI, and the risk of having poor collateral vessel development is significantly increased. However, this might be reflecting the cluster of risk factors, associated with metabolic syndrome, in which insulin resistance plays a major role.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Meininger CJ, Schelling ME, Granger HJ . Adenosine and hypoxia stimulate proliferation and migration of endothelial cells. Am J Physiol 1988; 255: H554–H562.

    CAS  PubMed  Google Scholar 

  2. Schaper W . Angiogenesis in the adult heart. Basic Res Cardiol 1991; 86 (Suppl 2): 51–56.

    PubMed  Google Scholar 

  3. Chilian WM, Mass HJ, Williams SE, Layne SM, Smith EE, Scheel KW . Microvascular occlusions promote coronary collateral growth. Am J Physiol 1990; 258: H1103–H1111.

    CAS  PubMed  Google Scholar 

  4. Levy AP, Levy NS, Wegner S, Goldberg MA . Transcriptional regulation of the rat vascular endothelial growth factor gene by hypoxia. J Biol Chem 1995; 270: 13333–13340.

    Article  CAS  Google Scholar 

  5. Abaci A, Oguzhan A, Kahraman S, Eryol NK, Unal S, Arinc H, Ergin A . Effect of diabetes mellitus on formation of coronary collateral vessels. Circulation 1999; 99 (17): 2239–2242.

    Article  CAS  Google Scholar 

  6. Waltenberger J . Impaired collateral vessel development in diabetes: potential cellular mechanisms and therapeutic implications. Cardiovasc Res 2001; 49: 554–560.

    Article  CAS  Google Scholar 

  7. Abbott RD, Donahue RP, Kannel WB, Wilson PF . The impact of diabetes on survival following myocardial infarction in men vs women: the Framingham study. JAMA 1988; 260: 3456–3460.

    Article  CAS  Google Scholar 

  8. Jonsson S, Hedblad B, Engstrom G, Nilsson P, Berglund G, Janzon L . Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22,025 men from an urban Swedish population. Int J Obes Relat Metab Disord 2002; 26 (8): 1046–1053.

    Article  CAS  Google Scholar 

  9. Cohen M, Rentrop KP . Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation 1986; 75: 325–334.

    Google Scholar 

  10. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH . The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523–1529.

    Article  CAS  Google Scholar 

  11. NHLBI Obesity Education Initiative. Summary report: strategy development workshop for public education on weight and obesity. NIH Publication 94-3314 National Institutes of Health: Bethesda, MD; 1994. p. 139.

  12. Messerli FH, Sundgaard-Riise K, Reisin ED et al. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med 1983; 99: 757–761.

    Article  CAS  Google Scholar 

  13. 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.

    Article  CAS  Google Scholar 

  14. Rosengren A, Wedel H, Wilhelmsen L . Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality. A prospective population study. Eur Heart J 1999; 20: 269–277.

    Article  CAS  Google Scholar 

  15. Manson JE, Colditz GA, Stampfer MJ et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322: 882–889.

    Article  CAS  Google Scholar 

  16. Helfant RH, Vokonas PS, Gorlin R . Functional importance of the human coronary collateral circulation. New Engl J Med 1971; 284: 1277–1281.

    Article  CAS  Google Scholar 

  17. Habib GB, Heibig J, Forman SA et al. Influence of coronary collateral vessels on myocardial infarct size in humans, results of phase I thrombolysis in myocardial infarction (TIMI) trial. Circulation 1991; 83: 739–746.

    Article  CAS  Google Scholar 

  18. Hansen JF . Coronary collateral circulation, clinical significance and influence on survival in patients with coronary artery disease. Am Heart J 1989; 117: 290–295.

    Article  CAS  Google Scholar 

  19. Shweiki D, Itin A, Soffer D et al. Vascular endothelial growth factor induced by hypoxia may mediate hypoxia-initiated angiogenesis. Nature 1992; 359: 843–845.

    Article  CAS  Google Scholar 

  20. Lee SH, Wolf PL, Escudero R et al. Early expression of angiogenesis factors in acute myocardial ischemia and infarction. N Engl J Med 2000; 342: 626–633.

    Article  CAS  Google Scholar 

  21. Chou E, Suzuma I, Way KJ et al. Decreased expression of vascular endothelial growth factor and its receptors in insulin resistant and diabetic states. Circulation 2002; 105: 373–379.

    Article  CAS  Google Scholar 

  22. Onat A, Büyükbese MA, Ural D, Keles I, Ural E, Sansoy V . Sigara icimi, obesite, fizik aktivite ve diyabet: Marmara bolgesi halkinda nereye yoneliyor? Arch Turk Soc Cardiol 1998; 26: 72–78.

    Google Scholar 

  23. Schaper W, Gorge G, Winkler B, Schaper J . The collateral circulation of the heart. Prog Cardiovasc Dis 1988; 31: 57–77.

    Article  CAS  Google Scholar 

  24. Ferguson RJ, Petitclerc R, Choquette G et al. Effect of physical training on treadmill exercise capacity, collateral circulation and progression of coronary disease. Am J Cardiol 1974; 34: 764–769.

    Article  CAS  Google Scholar 

  25. Blair SN . Evidence for success of exercise in weight loss and control. Ann Intern Med 1993; 119: 702–706.

    Article  CAS  Google Scholar 

  26. Andersen RE, Wadden TA, Bartlett SJ et al. Effects of life-style activity versus structured aerobic exercise in obese women. A randomized trial. JAMA 1999; 281: 335–340.

    Article  CAS  Google Scholar 

  27. Wackers FJTh . Myocardial perfusion imaging. In: Sandler MP, Coleman RE, Wackers FJTh et al (eds) Diagnostic nuclear medicine, 3rd edn. Williams & Wilkins: Baltimore; 1995. p. 443.

    Google Scholar 

  28. Charney R, Cohen M . The role of the coronary collateral circulation in limiting myocardial ischemia and infarct size. Am Heart J 1993; 126: 937–945.

    Article  CAS  Google Scholar 

  29. Pijls NH, Bech GJ, el Gamal MI et al. Quantification of recruitable coronary collateral blood flow in conscious humans and its potential to predict future ischemic events. J Am Coll Cardiol 1995; 25: 1522–1528.

    Article  CAS  Google Scholar 

  30. Fletcher GF, Blair SN, Blumenthal J et al. Statement on exercise: benefits and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation 1992; 86: 340–344.

    Article  CAS  Google Scholar 

  31. Hubert HB, Feinleib M, McNamara P, Castelli WP . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up in the Framingham Heart Study. 1983; 67: 968–977.

Download references

Author information

Authors and Affiliations

  1. Yuksek Ihtisas Hospital, Cardiology Clinic, Sihhiye, Ankara, Turkey

    M B Yilmaz, S F Biyikoglu, Y Akin, U Guray, H L Kisacik & S Korkmaz

Authors
  1. M B Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S F Biyikoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y Akin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U Guray
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H L Kisacik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Korkmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M B Yilmaz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yilmaz, M., Biyikoglu, S., Akin, Y. et al. Obesity is associated with impaired coronary collateral vessel development. Int J Obes 27, 1541–1545 (2003). https://doi.org/10.1038/sj.ijo.0802474

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802474

Keywords

This article is cited by

Search

Advanced search

Quick links