Key result
Metabolically unhealthy non-obese phenotype linked to ~27% higher 3-year post-PCI CV risk.
Why the study?
The prognostic impact of distinct metabolic phenotypes after PCI in patients with coronary artery disease remains unclear.
Does the metabolically unhealthy non-obese phenotype increase cardiovascular risk in patients undergoing PCI compared to the metabolically healthy non-obese phenotype?
Cohort (n=23,882)
No
Does the metabolically unhealthy non-obese phenotype increase cardiovascular risk in patients undergoing PCI compared to the metabolically healthy non-obese phenotype?
Hazard Ratio: 1.27 (95% CI 1.07–1.52)
In patients undergoing PCI, the metabolically unhealthy non-obese phenotype is associated with a significantly higher risk of cardiovascular events compared to metabolically healthy non-obese patients.
MUN phenotype signals higher post-PCI CV risk; leaves open whether metabolic stratification refines risk prediction beyond conventional factors.
Obesity and metabolic abnormalities are risk factors for cardiovascular (CV) events in patients with coronary artery disease (CAD). However, the prognostic impact of distinct metabolic phenotypes after percutaneous coronary intervention (PCI) remains unclear. We enrolled 23,882 patients undergoing PCI at Fuwai Hospital between 2017 and 2018. Obesity was defined as body mass index (BMI) ≥ 28.0 kg/m 2 , and metabolic unhealth was defined as diabetes or hypertension plus dyslipidemia. Patients were classified into four phenotypes: metabolically healthy non‐obese (MHN), metabolically healthy obese (MHO), metabolically unhealthy non‐obese (MUN), and metabolically unhealthy obese (MUO). Primary endpoint was 3‐year CV events, including CV death, non‐fatal MI, and non‐fatal stroke. During a median follow‐up of 36 months, 757 (3.2%) CV events occurred. Compared with MHN, MUN was associated with higher CV risk (HR 1.27, 95% CI 1.07–1.52). The excess risk in MUN was mainly driven by non‐fatal MI (HR 1.47, 95% CI 1.09–1.99) and stroke (HR 1.71, 95% CI 1.07–2.75). Among metabolically unhealthy patients, non‐obese individuals had higher all‐cause mortality than obese individuals (HR 1.50, 95% CI 1.12–2.02). Metabolically unhealthy non‐obese patients had increased CV risk after PCI. Metabolic phenotype stratification may improve risk prediction in CAD patients.
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Li et al. (2026) conducted a cohort in coronary artery disease undergoing percutaneous coronary intervention (n=23,882). Metabolically unhealthy non-obese (MUN) phenotype vs. Metabolically healthy non-obese (MHN) phenotype was evaluated on 3-year CV events, including CV death, non-fatal MI, and non-fatal stroke (HR 1.27, 95% CI 1.07-1.52). Metabolically unhealthy non-obese patients had a higher risk of 3-year cardiovascular events after PCI compared to metabolically healthy non-obese patients (HR 1.27; 95% CI 1.07-1.52).
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