LAUSR

Objective: Several risk factors, including smoking habits, hypertension, obesity and diabetes, are negatively associated with adverse cardiovascular events. Acute ST-elevation myocardial infarction (STEMI) is a serious problem associated with a high burden of cardiac disease. To determine if obese hypertensive patients had a different clinical presentation and/or a poorer outcome, mainly related to hemorrhagic complications and major adverse cardiovascular events (MACE). Design and method: Retrospective single center cohort study enrolled 121 patients with STEMI diagnosis, admitted to our intensive unit care. In-hospital hemorrhagic complications (IHHC) included intracerebral hemorrhage, resulting in hemodynamic compromise or requiring a blood transfusion were accessed. MACE was a composite endpoint of in-hospital cardiovascular death and sustained ventricular arrhythmic events. Results: The mean age was 58.3 ± 12.7 years and 102 were male (84.3%). Thirty-six patients (29.8%) were overweight and twenty-four (19.8%) were obese. Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes (42.1% vs. 13.8%, respectively; p 0.021). Obese hypertensive patients were mainly women (52.6% vs. 27.5%; p 0.030). There were no statistically differences in other comorbidities between genders. All obese hypertensive patients were medicated for hypertension, 15 (39.5%) with one drug and 7 (18.4%) with two drugs. The mean systolic blood pressure (SBP) at presentation was 126 ± 2.3 mmHg and diastolic blood pressure was 78.5 ± 1.5 mmHg. Obese hypertensive patients had higher blood pressure values (SBP mean 136 ± 33 mmHg), but no differences in symptoms (p 0.20) or Killip-Kimball classification (p 0.93) were evident. Regarding to in-hospital hemorrhagic complications, females had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), but it was independent of other comorbidities, including hypertension, obesity or diabetes (r = 0.249; ANOVA p-value < 0.005). In the subset of obese hypertensive patients, no differences in IHHC (p 0.56) or MACE (p 0.18) were detected. Conclusions: Obese hypertensive patients were mainly women medicated with one drug. Despite higher blood pressure values, this group had similar outcomes, including hemorrhagic events. The authors advocate that a good control of risk factors is crucial to minimize their impact on clinical outcomes.