Key result
The metabolically sick obese phenotype was associated with a significantly higher prevalence of carotid atherosclerosis compared to the metabolically healthy non-obese phenotype (OR 2.28), an effect that was more pronounced in patients under 60 years of age.
Why the study?
It was unclear whether aging influences the effect of metabolic phenotypes on cardiovascular risk, evaluated by IMT-CC, in patients with coronary heart disease.
Does age influence the association between metabolic phenotypes and carotid atherosclerosis in patients with coronary heart disease?
Cross-Sectional (n=939)
Does age influence the association between metabolic phenotypes and carotid atherosclerosis in patients with coronary heart disease?
Odds Ratio: 2.28 (95% CI 1.47–3.53)
Absolute Event Rate: 54% vs 33.9%
p-value: p=0.003
Metabolically healthy obese patients aged ≥60 years have a similar risk of carotid atherosclerosis as those with metabolic disease, indicating a loss of metabolic flexibility with age.
Indicates reduced metabolic flexibility after age 60 in CHD; hypothesis-generating for phenotype-targeted strategies, needs prospective validation.
BACKGROUND: Aging is associated with a high risk for cardiovascular disease. The relation of obesity and risk of cardiovascular events appears to be more closely linked to certain clinical or metabolic phenotypes than to obesity itself. Our aim was to establish whether aging influenced the metabolic phenotypes regarding to cardiovascular risk, evaluated by changes in the intima media thickness-common carotid (IMT-CC), in coronary heart disease (CHD) patients. METHODS: In this cross-sectional study, 1002 CHD patients were studied at entry from the CORDIOPREV study. We performed carotid ultrasound assessment to obtain their IMT-CC values. Carotid atherosclerosis was considered to exist if IMT-CC > 0.7 mm. RESULTS: Age determined a higher IMT-CC, regardless metabolic phenotype (all p < 0.05). Metabolically healthy non-obese (MHNO) aged< 60 showed a lesser prevalence for carotid atherosclerotic disease than metabolically sick non-obese (MSNO) and obese (MSO), while MHNO aged≥60 only showed less prevalence for the disease than the MSO. Carotid atherosclerosis associated with age, sex, impaired fasting glucose (IFG), hypertension and high sensitivity C-reactive protein (hsCRP). However, in patients aged< 60, it associated with sex and IFG and in the age ≥ 60 group, with hypertension and hsCRP. CONCLUSIONS: Our results suggest that CHD patients aged≥60 are less metabolic flexible compared to patients aged< 60. Thus, MHO patients aged≥60 show the same risk of suffering carotid atherosclerosis as those with metabolic disease, while MHO patients aged< 60 show lower risk than MSO. This fact indicates the need to focus on therapeutic strategies in order to modify those parameters related to obesity and metabolic inflexibility in patients with CHD before entering old age.
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Gutierrez‐Mariscal et al. (2020) conducted a cross-sectional in Coronary heart disease (n=939). Metabolically sick obese (MSO) phenotype vs. Metabolically healthy non-obese (MHNO) phenotype was evaluated on Carotid atherosclerotic disease (IMT-CC ≥ 0.7 mm) (OR 2.28, 95% CI 1.47-3.53, p=0.003). The metabolically sick obese phenotype was associated with a significantly higher prevalence of carotid atherosclerosis compared to the metabolically healthy non-obese phenotype (OR 2.28), an effect that was more pronounced in patients under 60 years of age.
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