Association of coronary artery disease with cardiac arrhythmias in men of working age with obesity

The purpose is to study the prevalence of coronary heart disease and the structure of rhythm disturbances in overweight and obese men of working age, as well as to establish the relationship between the presence of arrhythmias and coronary heart disease, depending on various clinical, laboratory and instrumental risk factors. Material and methods. The study included 184 male patients aged 25 to 64 years [44.4 ± 8.0] who applied for routine medical examination and treatment. The patients were divided into 3 groups depending on body mass index (BMI), followed by a comprehensive clinical, laboratory and instrumental examination and analysis of the results in groups. Statistical processing was performed using parametric and nonparametric analysis methods on a personal computer using statistical programs in the environment Exel 97.0 and Statistica for Windows 6.0. The differences were considered statistically significant at p < 0.05. Results. Three groups of patients were examined depending on the BMI value: group I — 40 people with normal body weight (BW), average BMI of 23.3 ± 1.3 kg/m²; group II — 46 people with excess BW, average BMI of 27.3 ± 1.5 kg/m²; group III — 98 people with obesity 1–3 degrees, average BMI 34.9 ± 5.0 kg/m². It was found that an increase in BW is associated with an increase in the frequency of coronary artery disease (CAD): with normal BW — 10% of patients had CAD, with excessive BW — 50.0%, with obesity — 58.2% (I–II p < 0.001; I–III p < 0.001; II–III p < 0.604), and in the group of patients with CAD was not observed before the age of 35, among patients aged 35-50 years, its frequency was 23.9%, over 50 years-52.9% (pχ² < 0.001). It has been shown that the increase in BW is accompanied by a statistically significant increase in the frequency of paired supraventricular extrasystoles  ( SVES), ventricular extrasystoles ( VES) > 200 per day, allorhythmic VES and atrial fibrillation (AF). Moreover, the risk of arrhythmias, depending on BMI, increases only with associated CAD, the presence of which significantly increases the relative risk (RR) of VES in general by 3.78 times (p < 0.001), high-grade VES by 2.18 times (p < 0.002), frequent VES by 3.3 times (p = 0.017), allorhythmic VES by 4.13 times (p = 0.007). In the development of VES, such potentiating factors in the study group may play a role as: left ventricular hypertrophy (LVH) (p = 0.038), LV diastolic dysfunction (p = 0.032), low serum high density lipoprotein cholesterol (HDL) (p = 0.029), as well as an exceeding the reference values content of adiponectin (А), which directly correlated with the daily number of VES (r = +0.34, p = 0.043). Conclusion. There is a relationship between increased BW and the frequency of arrhythmias such as SVES, VES, allorhythmic VES and AF as the age of patients increases. However, this pattern is peculiar only to persons with CAD, the presence of which in case of obesity and excessive BW plays the role of a significant risk factor for the development of ventricular arrhythmias, which has not been revealed with respect to supraventricular (AF, SVES) rhythm disturbances. Among the risk factors associated with the development of ventricular arrhythmias in CAD and obesity, left ventricular diastolic dysfunction (LVDD), left ventricular hypertrophy (LVH), low serum high density lipoprotein cholesterol (HDL) and hyper adiponectinemia should be noted. 

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