Abstract
BackgroundRecent studies have suggested that metabolic health may contribute more to the atherosclerosis than obesity. The aim of this study is to compare coronary artery calcium scores (CACS) among patients with different metabolic health and obesity status.MethodsA health-screening program of 24,063 participants (mean age 41 years) was conducted, and CACS was assessed by multi-detector computerized tomography (MDCT). Being metabolically healthy was defined as having fewer than two of the following risk factors: high blood pressure, high fasting blood glucose, high triglyceride, low high-density lipoprotein cholesterol, highest decile of homeostasis model assessment-insulin resistance (HOMA-IR) index, and highest decile of high-sensitivity C-reactive protein (hs-CRP). Obesity status was defined as body mass index (BMI) higher than 25 kg/m2. Analyses were performed in four groups divided according to metabolic health and obesity: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUHNO), and metabolically unhealthy obese (MUHO).ResultsMean values of CACS in the four groups were significantly different, except those between MHNO and MHO and between MUHNO and MUHO. When multinomial logistic regression analysis was performed with five CACS categories as the dependent variables and after adjusting for age, sex, and smoking status, the MHO, MUHNO, and MUHO groups showed significantly increased odds ratio for increasing CACS categories compared with no calcification status (5.221 for CACS >400 in MUHO group with 95% CI 2.856∼5.032 with MHNO group as the reference). When other variables including the metabolic parameters were included in the same model, the risks were attenuated.ConclusionMetabolic health is more closely associated with subclinical atherosclerosis than obesity as assessed by CACS.
Highlights
Obesity is the main cause of various metabolic diseases and its ultimate consequence is increased risk of cardiovascular disease [1]
This new concept led to the creation of the new term, ‘‘metabolically healthy obesity (MHO),’’ which refers to obese subjects who satisfy the current definition of obesity without satisfying the criteria for being metabolically unhealthy, such as having insulin resistance, elevated blood pressure, dyslipidemia, or elevated surrogate markers of systemic inflammation [4]
Comparison of the parameters among the four groups divided by metabolic health and obesity status was analyzed by one-way ANOVA test, and analysis of covariance (ANCOVA) test was performed to adjust for age and sex
Summary
Obesity is the main cause of various metabolic diseases and its ultimate consequence is increased risk of cardiovascular disease [1]. Being obese means excess body fat content and having the consequences of ‘‘inflamed fat,’’ or metabolic derangements such as diabetes, insulin resistance, vascular inflammation, and atherosclerosis [2]. Recent studies have suggested that an obesity phenotype may present without these metabolic derangements; obesity is not necessarily equivalent to poor metabolic health [3]. This new concept led to the creation of the new term, ‘‘metabolically healthy obesity (MHO),’’ which refers to obese subjects who satisfy the current definition of obesity without satisfying the criteria for being metabolically unhealthy, such as having insulin resistance, elevated blood pressure, dyslipidemia, or elevated surrogate markers of systemic inflammation [4]. The aim of this study is to compare coronary artery calcium scores (CACS) among patients with different metabolic health and obesity status
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