Predictors of an unfavorable outcome in patients with acute coronary syndrome, depending on the body mass index

Obesity is a global epidemic, affecting 890 million adults (11.8%) in 2024 and projected to reach 1.02 billion (18%) by 2030. In Russia, prevalence is estimated at 20%. It commonly coexists with coronary heart disease, atherosclerosis, type 2 diabetes mellitus, and hypertension, worsening clinical outcomes. The ‘obesity paradox’ describes improved prognosis in overweight patients, while obesity accelerates the onset of acute coronary syndrome (ACS) by 3.9 to 7.7 years. Objective. To examine clinical characteristics, identify predictors of long-term adverse outcomes, and assess 10-year survival in patients with acute coronary syndrome stratified by body mass index. Materials and methods. This study included 1100 patients (714 men and 386 women) treated for ACS in 2015 at the Chelyabinsk Regional Clinical Hospital. Patients were classified by ACS type: Group 1 (n=647) with myocardial infarction and Group 2 (n=453) with unstable angina pectoris. Body mass index (BMI) was calculated using the Quetelet formula. According to the World Health Organization classification (2004), patients were grouped as follows: normal weight (BMI <24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obesity (BMI ≥30 kg/m2). Statistical analyses were performed using Microsoft Excel and Statistica 19.0. Results. In patients with ACS, obesity is associated with a higher prevalence of risk factors such as hypertension, type 2 diabetes mellitus, advanced age, and female gender. For myocardial infarction, overweight and obesity are linked to a lower risk of poor outcome and mortality compared to normal weight, consistent with the «obesity paradox». However, across all forms of ACS, the main predictors of adverse outcomes are male gender, advanced age, and type 2 diabetes mellitus. Conclusions. Obesity may be associated with improved short-term prognosis, but male gender and type 2 diabetes substantially increase the risk of adverse outcomes.