Extent and composition of coronary lesions and degree of cardiac hypertrophy in relation to abdominal fatness in men under 40 years of age

The relationship of the extent and composition of coronary lesions and the degree of cardiac hypertrophy to anthropometric indicators of abdominal fatness and the amount of intra-abdominal fat was investigated in a group of 32 forensic autopsy cases that consisted of sudden deaths from violent causes of previously healthy men under 40 years of age. Body height and weight, waist and hip circumferences, and the thickness of the subscapular and abdominal subcutaneous fat were measured; the body mass index (BMI) and waist-to-hip ratio (WHR) were calculated; and omental, mesenteric, and perirenal fat deposits and the heart were weighed. The degree of coronary narrowing was determined visually, and the extent of coronary lesions was measured by planimetry. The thickness of the intima and intima-media was measured by computerized image analysis. Intimal macrophage foam cells and smooth muscle cells were detected by immunohistochemistry. Significant positive correlations were found between WHR and the overall degree of coronary narrowing and the intima-media thicknesses of the left anterior descending artery and right coronary artery when adjusted for age. Intima-media thickness was also related to tertiles of WHR. Heart weight indexed to height showed a significant positive correlation with BMI, waist circumference, WHR, and the size of intra-abdominal fat deposits, of which WHR was the best predictor of mild cardiac hypertrophy. The results indicate that the severity of clinically silent lesions in the atherosclerosis-prone regions of the coronary arteries is associated with WHR in young male individuals who also have mild myocardial hypertrophy associated with abdominal fatness and an accumulation of intra-abdominal fat. These associations between fat distribution and early cardiovascular changes point to a powerful need for preventive action with respect to weight gain in young men to alleviate progression of the lesions.