Obesity and Chest Pain Presentation among Yemeni Adults with Angina and Nonobstructive Coronary Arteries: A Cross-Sectional Study

Abstract

Objective: To determine whether obesity was associated with chest pain rather than dyspnea-only presentation among Yemeni adults with angina and nonobstructive coronary arteries (ANOCA) and to explore differences in cardiovascular risk factors, laboratory parameters, routine echocardiographic and angiographic findings, and medication exposure according to obesity status. Methodology: This hospital-based cross-sectional study included 151 consecutive Yemeni adults undergoing elective invasive coronary angiography. Eligible participants presented with chest pain or dyspnea considered an angina-equivalent symptom and had either no visible epicardial coronary stenosis or <50% stenosis in all major epicardial vessels. Obesity was defined as body mass index ≥30 kg/m². Seven participants with overlapping chest pain and dyspnea indicators were excluded only from the primary presentation-specific analysis, leaving 144 participants. Results: Of 151 participants, 49 (32.5%) were obese. Among the 144 participants with an unambiguous symptom classification, 108 (75.0%) presented with chest pain and 36 (25.0%) with dyspnea without chest pain. Chest-pain presentation occurred in 38/49 obese participants (77.6%) and 70/95 non-obese participants (73.7%; p=0.612). Obesity was not associated with chest-pain presentation after adjustment for age, sex, diabetes mellitus, and hypertension (aOR 1.21, 95% CI 0.53–2.78; p=0.648). A sensitivity analysis including all 151 participants produced a similar result (aOR 1.11, 95% CI 0.49–2.54; p=0.802). In exploratory analyses, obese participants had higher median LDL-C (120.0 vs 110.5 mg/dL; p=0.007), lower median HDL-C (37.0 vs 42.0 mg/dL; p=0.027), and a greater prevalence of HDL-C <40 mg/dL (55.1% vs 33.3%; p=0.011). Laboratory-defined composite dyslipidemia and routine echocardiographic and angiographic findings did not differ significantly between obesity groups. Conclusions: Obesity was not statistically associated with chest pain rather than dyspnea-only presentation among Yemeni adults with ANOCA. Differences in LDL-C and HDL-C were observed in exploratory analyses but require confirmation.