Abstract: Objective To investigate the correlation between body mass index (BMI) and vasospastic angina (VSA) in the elderly patients with hypertension. Methods This retrospective case-control study enrolled 100 elderly hypertensive patients presenting with VSA (VSA group) at Xuzhou Central Hospital from January 2019 to January 2024. The diagnosis was confirmed via rest-cold pressor single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The control group (non-VSA group) was matched 1∶1 from elderly hypertensive patients with normal SPECT MPI results and no VSA evidence in the same period. Clinical parameters, including age, gender, BMI, diabetes, smoking history, lipid profiles, fasting plasma glucose (FPG), serum creatinine, estimated glomerular filtration rate, and echocardiographic data were compared between the two groups. Multivariate logistic regression was performed to identify independent risk factors for VSA. Restricted cubic spline (RCS) analysis was employed to evaluate the dose-response relationship between BMI and the risk of VSA. Spearman’s rank correlation was used to assess the correlation of BMI with myocardial ischemia severity such as summed stress score (SSS) and total perfusion defect (TPD). Results Compared to non-VSA group, the levels of BMI, left ventricular diameter (LV), transiet ischemic dilation (TID), FPG, triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C)and the prevalence of diabetes were significantly higher, and the level of high-density lipoprotein cholesterol (HDL-C) was significantly lower in VSA group (all P<0.05). Multivariate logistic regression analysis showed BMI, LV and diabetes were independent risk factors for VSA (P< 0.05). RCS analysis revealed a linear positive correlation between BMI and VSA risk (P for overall trend<0.05; P for nonlinearity > 0.05). In the elderly hypertensive patients with BMI＞24.6, the increase in BMI significantly increased the risk of VSA. Spearman’s rank correlation analysis indicated a positive association between BMI and both SSS and TPD grades (P<0.05). Conclusions In the elderly hypertensive patients, BMI is an independent risk factor for VSA, with a linear dose-response relationship. Higher BMI correlates with greater severity of myocardial ischemia caused by VSA.

Key words: body mass index, vasospastic angina, aged, hypertension, myocardial ischemia