Obesity and Metabolic Syndrome in Acute Promyelocytic Leukemia in Appalachia: A Single-Center Retrospective Analysis
Authors: Holley Nolan , Shultz Carl 
Published: December 2024

Introduction:
Metabolic syndrome is a condition that is used to identify patients that are at an increased risk for coronary artery disease (CAD), cerebrovascular disease (CVD), and type two diabetes mellitus (T2DM). Criteria includes elevated triglycerides, decreased high-density lipoprotein, elevated blood pressure, insulin resistance, and increased waist circumference. The Appalachian region has a disproportionate prevalence of obesity and metabolic syndrome when compared with other regions in the United States. Poverty, barriers to healthcare access, transportation difficulties, and food deserts have been attributed and contribute to poor health outcomes. Increased body mass index (BMI) and hyperlipidemia have been suggested as risk factors for acute promyelocytic leukemia (APL). The aim of this study is to elucidate the burden of obesity and metabolic syndrome in patients with APL at West Virginia University Hospitals (WVUH), an institution providing care predominantly to West Virginia, which is the only state located entirely within Appalachia.
Methods:
An IRB-approved, single-institution, retrospective electronic health record review was completed for all patients with APL from January 2000 to June 2024 at WVUH. Patient demographics, date of APL diagnosis, and BMI were recorded. Each chart was reviewed for components of metabolic syndrome including dyslipidemia, T2DM, prediabetes, and hypertension. Lastly, lipid-lowering agents, antihypertensive, and antihyperglycemic medications were analyzed. Waist circumferences were not available for analysis.
Results:
The study sample (n=91) had a median age of 56.5 (IQR=44.8, 68.3) with 47.3% males and 52.7% females. The median BMI of the cohort was 31.2 (IQR=27.5, 37.0). Obesity was present in 54 patients (59.3%), with 22 patients (24.2%) having class I obesity, 17 patients (18.6%) having class II obesity, 15 patients (16.4%) having class III obesity, and 28 patients (30.8%) having overweight. Overall obesity prevalence was found to be greater than the general prevalence of obesity in West Virginia of 39.7%. Hypertension was the most prevalent comorbid condition (64.8%), followed by dyslipidemia (51.6%), and T2DM or prediabetes (46.2%). Likewise, the most common medications were antihypertensives (61.5%), followed by lipid-lowering agents (49.5%), and antihyperglycemics (39.5%).
Conclusions:
In a region with a disproportionate prevalence of obesity, metabolic syndrome, and associated comorbidities at baseline, patients with APL in this region have an even greater prevalence of obesity, dyslipidemia, hypertension, and T2DM or prediabetes. The findings of this study suggest a potential underlying linkage between obesity, metabolic syndrome, and APL in a rural Appalachian population. Future studies should seek to further characterize the associations between APL and obesity with metabolic syndrome with regards to patient outcomes. Taken together, this study suggests that the implications of high rates of obesity and metabolic syndrome may reach far beyond risk for CAD, CVD, and T2DM in Appalachia; they could indicate risks for hematologic malignancies such as APL as well.