Background: The obesity epidemic is a significant health concern, affecting nearly a third of all United States citizens according to the 2013-2014 National Health and Nutrition Examination Survey. Obesity contributes to multiple metabolic and cardiovascular risk factors including diabetes mellitus, hypertension, and dyslipidemia. The atherosclerotic cardiovascular disease (ASCVD) risk calculator is a frequently used tool that aggregates various risk factors to assist physicians in detecting patients that may benefit from statin therapy and risk factor modification. However, this calculator does not directly factor in obesity, which has been found to be associated with multiple cardiovascular comorbidities. Our goal was to assess the correlation between body mass index (BMI) and ASCVD risk scores in order to identify potential targets for intervention to further decrease ASCVD risk.
Methods: We obtained data from the medical record data warehouse of a primary care outpatient clinic predominantly run by internal medicine residents within a large safety-net hospital from January to December 2015. Patients with a diagnosis of dyslipidemia or hyperlipidemia were identified and electronic medical records were reviewed. ASCVD risk scores were calculated using the American College of Cardiology ASCVD risk estimator. Linear and logistical regression analyses were performed using SPSS software to assess the correlation between BMI and ASCVD risk.
Results: The patient population was predominantly African American (92%, 1771 of 1919). Obesity (BMI ≥30) was present in 63% (1207 of 1919) of patients. ASCVD scores could be calculated for 914 patients and 90% (823 of 914) of these patients had ASCVD risk scores ≥7.5. However, only 84% (691 of 823) of these patients with elevated ASCVD scores were on a statin. Analyses did not reveal a correlation between BMI and ASCVD risk. However, elevated BMI (>25) conferred an increased odds ratio (O.R.) of having elevated ASCVD risk (>22.5% O.R. 1.58; p value 0.02) in comparison to normal or underweight BMI.
Conclusion: Obesity rates appear to be higher in our patient population in comparison to national estimates but our mathematical model cannot be used to explain any correlation between BMI and ASCVD risk scores. Obesity did not confer an increased ASCVD risk in comparison to being overweight (BMI 25-29.9). However, both overweight and obese patients had a higher likelihood of having a significantly elevated ASCVD risk score. Future aims include initiating a targeted educational intervention for residents in the continuity clinic to ultimately demonstrate that resident driven intervention is an effective way to address obesity and modify ASCVD risk.