Angina symptoms and quality of life after tailored therapy in obese patients presenting with ischemia and non-obstructive coronary arteries: findings from the INOCA-IT registry

Obesity is a crucial risk factor involved in coronary artery disease (CAD); however, data about possible association with ischemia and non-obstructive CAD (INOCA) endotypes are limited and the effects of a tailored therapy in obese patients are poorly investigated. The aim of this sub-analysis was to investigate possible differences in terms of angina symptoms and quality of life between obese and non-obese patients as well as the effects of a tailored therapy in both groups.

The analysis was performed on data from the INOCA-IT Registry, which consecutively enrolled patients with angina and/or inducible myocardial ischemia, without obstructive CAD, who underwent full invasive coronary functional assessment. Obese patients were defined as those with a BMI ≥ 30 kg/m2. Angina symptoms and quality of life were assessed using respectively the Seattle Angina Questionnaire (SAQ) and the EQ-5D-5L questionnaire.

213 patients were included in the registry and 52 (24%) were considered obese. Women were equally represented (Obese group: 69% and Non-Obese group: 57%, p=0.14). Obese patients presented more often with hypertension (85%) and dyslipidemia (85%) as compared with Non-Obese patients (57%, p<0.01 and 66%, p<0.01). At the admission, no significant difference was found between the two groups in terms of symptoms classified according to the Canadian Cardiovascular Society (CCS), but a significant difference in terms of dyspnoea classified according to the New York Heart Association (NYHA) with a larger amount of obese patients classified in NYHA class 2 as compared with non-obese patients (61% vs 40%, p=0.04). In addition, obese patients presented with a significantly lower SAQ summary score (55±13 vs 60±15, p=0.04) and SAQ angina frequency domain (51±23 vs 59±26, p=0.04) as compared with non-obese patients. Although the EuroQol Visual Analogue Scale (EQ-VAS) did not significantly differ between the two groups, obese patients showed higher EQ-5D-5L domains for mobility, self-care and pain discomfort (Figure 1). The prevalence of both INOCA and CMD endotypes did not significantly differ between the two groups. Stratified medical therapy was significantly effective in improving both symptoms and quality of life in both groups. However, at follow up, obese patients presented with significantly higher EQ5D5L domain values for mobility (1.58 ± 0.76 vs 1.28±0.59, p=0.01) and usual activity (1.63±0.77 vs 1.38±0.67, p=0.048) as compared with non-obese patients (Figure 2).

Among patients presenting with INOCA, obese patients had higher prevalence of cardiovascular risk factors as compared with non-obese patients, with more severe symptoms at admission and no differences in terms of INOCA endotypes distribution. At 12-months follow-up, medical therapy was equally effective in both groups, however obese patients still presented with poorer mobility and usual activity scores.Figure 1.For image description, please refer to the figure legend and surrounding text.  Figure 2.For image description, please refer to the figure legend and surrounding text.