The physique associated with coronary artery disease
Williams, Simon Robert Pask
Cardiff Metropolitan University
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Studies within this thesis have investigated various aspects of the relationship between physique, coronary artery disease (CAD) and certain CAD risk factors. Data presented was collected on two separate occasions. Firstly, in a hospital setting on men undergoing investigative coronary angiography (CAD men), and secondly during a university health-screening programme (healthy men). Physique has been described using body mass and height, somatotype, skinfolds, girth measurements and various skinfold and girth ratios. CAD risk factors were related to 'metabolic fitness' : fasting serum glucose, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and the LDL-C ; HDL-C ratio. A unique aspect of certain studies is that a proportionality technique was used to adjust the anthropometric measurements for variation in body mass and stature. Also, an angiographic scoring system was used to describe the severity of atherosclerosis as a continuous rather than dichotomous variable. Anthropometric measurements were not related to the severity of atherosclerosis and there was no discernible pattern of subcutaneous adiposity (skinfolds) in the CAD or healthy men. However, in relation to age-matched healthy men, the CAD men were heavier (P < 0.01), had a greater BMI (P < 0.01), biceps skinfold (P < 0.05) and subscapular skinfold (P < 0.001). The CAD men also had significantly greater waist and abdominal girths, abdominal sagittal diameter (ASD), waist-to-hip ratio (WHR), abdomen-to-hip ratio (AHR'), waist-to-thigh ratio (WTR), waist-to-height ratio (WHtR) and ASD-to-height ratio (ASD/HI) (all P < 0.001). When the skinfolds and girths were adjusted for variation in stature the differences in biceps and subscapular skinfolds, and waist and abdominal girths remained. However, when adjusted for body mass variation the differences were no longer apparent. Abdomen and waist girths exhibited a closer association with TC, TG, HDL-C, LDL-C and the LDL-C : HDL-C ratio than skinfolds. A higher waist or abdominal girth was positively correlated with TG (P < 0.01), and the LDL-C : HDL-C ratio (P < 0.01) but negatively with HDL-C (P < 0.01). Adjusting for stature had no effect on these relationships, but adjusting for body mass reduced them considerably. In studies focusing on somatotype, both the CAD and healthy men were characterised by high ratings for endomorphy and mesomorphy but low ratings for ectomorphy. The CAD men had a small but significantly greater endomorphy rating (P = 0.038) and the healthy men had a small but significantly greater ectomorphy rating (P = 0.006). Somatotype was not related to the angiographic findings but a somatotype of low endomorphy and high ectomorphy was associated with a better metabolic profile in terms of cardiovascular disease risk. In conclusion, CAD men appear to have a physique characterised by abdominal obesity, a higher rating of endomorphy and a low rating for ectomorphy. However, a distinctive skinfold pattern is not apparent. Normalising anthropometric measurements for stature does not affect the relationship between elevated serum lipids and abdominal obesity but adjusting for body mass does.
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