HEMOSTATIC FUNCTION IN YOUNG SUBJECTS WITH CENTRAL OBESITY - RELATIONSHIP WITH LEFT-VENTRICULAR FUNCTION

This study was designed to evaluate coagulation and fibrinolysis activ ity and their relationship with left ventricular function in young obe se subjects with central fat distribution. We assessed coagulation and fibrinolysis activity by evaluation of factor VII activity, fibrinoge n and plasminogen, plasminogen activator inhibitor (PAI), and tissue p lasminogen activator antigen basally (tPA1) and after venous occlusion (tPA2). These measures were evaluated in young (<40 years) obese subj ects with central fat distribution in = 19) and in comparable lean sub jects in = 20). Blood glucose, triglycerides, total and high-density l ipoprotein (HDL) cholesterol, apolipoprotein (ape) Al and apo B, fasti ng immunoreactive insulin, and lipoprotein(a) levels were also measure d by current methods. Left ventricular ejection fraction (LVEF) and pe ak filling rate (PFR) determined by radionuclide angiocardiography and left ventricular mass (LVM) and LVM indexed for body height (LVM/H) d etermined by echocardiographic study were calculated. Central obesity was evaluated by the waist to hip ratio (WHR) according to the criteri a of the italian Consensus Conference of Obesity. Factor VII (P <.001) , fibrinogen (P <.001), plasminogen (P <.001), PAI activity (P <.001), tPA1 (P <.02), fasting blood glucose (P <.01), apo B (P <.02), and im munoreactive insulin (P <.01) were significantly higher in obese than in lean subjects. In contrast, HDL cholesterol (P <.01), tPA2 (P <.01) , LVEF (P <.001), and PFR (P <.02) were significantly lower in obese t han in lean subjects. In all subjects, WHR correlated directly with fi brinogen and inversely with tPA2; LVEF correlated inversely with tPA1, PAI, and fibrinogen; and PFR correlated inversely with factor VII act ivity. Multiple regression analysis indicated that WHR and PAI were in dependent predictors of LVEF. These results indicate that obese subjec ts with central fat distribution are characterized by a hypercoagulabl e state associated with a silent left ventricular dysfunction. Such al terations might be responsible for the higher cardiovascular risk in s ubjects with central obesity. Copyright (C) 1995 by W.B. Saunders Comp any