Key result
Metabolically healthy obesity with up to one metabolic abnormality increased the risk of coronary artery calcification progression (HR 1.653), whereas obesity with zero abnormalities did not.
Why the study?
Does the definition of metabolically healthy obesity (MHO class I vs class II) affect the risk of coronary artery calcium score (CACS) progression in subjects with baseline CACS of 0?
Cohort (n=1,218)
No
Does the definition of metabolically healthy obesity (MHO class I vs class II) affect the risk of coronary artery calcium score (CACS) progression in subjects with baseline CACS of 0?
Hazard Ratio: 1.653 (95% CI 1.144–2.39)
Absolute Event Rate: 24.2% vs 15.9%
p-value: p=0.007
The risk of coronary artery calcium progression in metabolically healthy obesity depends on the strictness of its definition, with risk increased only when up to 1 metabolic syndrome component is allowed, but not when 0 components are present.
MHO-CACS progression link varies by definition; leaves open whether MHO independently elevates risk or needs refined criteria in prospective studies.
OBJECTIVES: Debates whether metabolically healthy obesity (MHO) increases the cardiovascular risk might be due to the metabolic instability of MHO or the absence of a perfect definition of MHO. Therefore, we aimed to investigate the influence of the MHO phenotype on the coronary artery calcium score (CACS) progression according to definition of MHO. METHODS: We analyzed a retrospective cohort with a CACS of 0 at baseline and available serial CACS measurements taken ≥ 12 months apart (n = 1,218). Obesity was defined as BMI ≥ 25 kg/m2, and MHO was defined as obesity accompanied by ≤ 1 (MHO class I) or 0 (MHO class II) components of metabolic syndrome (MetS). RESULTS: During a median follow-up of 45 months, 32.2% of MHO class I and 10.2% of MHO class II subjects developed MetS. Compared to non-obese/metabolically healthy subjects (reference group), hazard ratios (HR) for development of MetS were 2.174 (95% confidence interval [CI]: 1.513-3.124) and 1.166 (95% CI: 0.434-3.129) for MHO class I and II subjects, respectively. The MHO class I subjects showed a significantly increased risk of CACS progression as compared to the reference group (HR: 1.653; 95% CI: 1.144-2.390), whereas MHO class II subjects did not (HR: 1.195; 95% CI: 0.514-2.778). Among subjects with MHO class I, no significant CACS progression was observed in the subjects who maintained metabolic health during follow-up (HR: 1.448; 95% CI: 0.921-2.278). CONCLUSIONS: The risks of metabolic deterioration and CACS progression were significant in subjects with MHO class I, but not in those with MHO class II.
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Yoon et al. (2017) conducted a cohort in Coronary artery calcification (n=1,218). Metabolically healthy obesity (MHO class I) vs. Metabolically healthy non-obese subjects was evaluated on Progression of coronary artery calcium score (CACS > 0) (HR 1.653, 95% CI 1.144-2.390, p=0.007). Metabolically healthy obesity with up to one metabolic abnormality increased the risk of coronary artery calcification progression (HR 1.653), whereas obesity with zero abnormalities did not.
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