Obesity may offer some protection after stenting

NEW YORK (Reuters Health) - Paradoxically, obesity may offer some protection against heart-related "events," like heart attack, in people who have a stent placed to prop open a clogged coronary artery, research shows.

In a study, researchers found that obese patients who had stents placed in diseased arteries had a lower incidence of adverse cardiac events than their normal-weight counterparts.

Larger randomized trials are needed to confirm or refute the obesity paradox seen in this and other relatively small studies of drug-eluting stents, Dr. Ahmed A. Khattab of the Segeberger Kliniken in Bad Segeberg, Germany, and colleagues note in a report in the American Journal of Cardiology.

A stent is a tiny hollow tube that is placed in the coronary arteries to maintain blood flow after the blood vessel has been dilated with angioplasty. In the past, stents were simply made out of metal and did not release any drugs. In recent years, several "drug-eluting"

stents have become available.

Khattab's team analyzed the outcomes at one year for 607 patients with coronary artery disease who were treated with stents that release the immune-suppressing drug sirolimus.

The group included 176 normal weight patients, 289 overweight patients, and 142 obese patients

At 30 days, the incidence of adverse cardiac events was 3.4 percent in the normal weight group and 3.1 percent in overweight patients, compared with just 2.8 percent in obese patients.

At one year, the combined cumulative incidence of death, heart attack, stroke, and repeat angioplasty or other "revascularization" procedure was higher in the normal weight patients (10.8 percent) and the overweight patients (11.8 percent) than in the obese patients (7.0 percent).

There was also "a clear trend" for a greater benefit from sirolimus-eluting stents compared with bare-metal stents with increasing body weight, the investigators report.

SOURCE: American Journal of Cardiology, June 2008.