Obesity, metabolic syndrome and cardiovascular prognosis: from the Partners coronary computed tomography angiography registry

Fig. 1. Odds of extensive CAD (Segment Involvement Score, SIS > 4), according to MetS and BMI. CAD coronary artery disease, MetS metabolic syndrome, BMI body mass index, kg/m2

Fig. 2. Absolute annualized adverse CV events demonstrated a J-shaped curve according to BMI (inset). The presence of MetS (dark bar) predicted worse outcomes within the BMI range of 20–39.9 kg/m2. CV cardiovascular, MetS metabolic syndrome, BMI body mass index, kg/m2

Fig. 3. Log hazard ratio according to body mass index (kg/m2) for cardiovascular adverse events (cardiovascular death, nonfatal MI, unstable angina requiring hospitalization, or coronary revascularization >90 days post-CTA). HR are unadjusted (top left), adjusted for all patients (top right) and adjusted and stratified by absence (bottom left panel) or presence (bottom right panel) of metabolic syndrome (MetS). Reference BMI was set at 20 kg/m2. An “obesity paradox,” where patients with relatively increased BMI from 20–40 kg/m2 had lower hazard of adverse CV events was observed particularly in the subjects without MetS, which may indicate residual confounding

Fig. 4. Cumulative incidence of adverse cardiovascular (CV) events (CV death, nonfatal MI, unstable angina requiring hospitalization, or coronary revascularization >90 days post-CTA), stratified by no MetS (left panel) and MetS (right panel) and normal CTA versus non-obstructive CAD (short dash line) versus obstructive CAD (long dash). Overall, patients with MetS experienced outcomes over 2× the rate of those without. Those with MetS and obstructive CAD experienced very high adverse events. The left panel was adjusted as in Fig. 3 for BMI, age, gender, current smoking, and hypertension. The right panel was adjusted as in Fig. 3 for BMI, age, gender, and current hypertension