Abstract
ObjectiveWe aimed to evaluate the association between the shift of metabolic status and future risk of carotid artery plaque (CAP) in community-based Chinese adults.MethodsThe current study included 9836 Chinese adults (4085 males and 5751 females, mean age 35.8 years) with metabolically healthy status at baseline (2013). Metabolically healthy status was defined as no self-reported history of metabolic diseases and cancer, and normal blood pressure, fasting blood glucose, glycated hemoglobin A1c level, and lipid profiles. Metabolically unhealthy status was defined if any of the following metabolic abnormalities were confirmed twice during follow up: high blood pressure, impaired glucose regulation, high triglycerides, high total cholesterol, high low-density lipoprotein cholesterols, or low high-density lipoprotein cholesterols. The transition was confirmed if participants’ metabolic status shifted from baseline healthy to unhealthy status during follow up (2014–2018).ResultsWe have identified 133 incident cases of CAP during follow up. Compared to those who remained metabolically healthy, the transition to high blood pressure, high total cholesterol, and high low-density lipoprotein cholesterols, were associated with high risk of developing carotid artery plaque (Hazards ratios (HRs) ranged from 1.69 to 2.34; p < 0.05 for all). The transition to impaired glucose regulation, high total triglycerides, and low high-density lipoprotein cholesterols, were associated with high risk of carotid artery plaque only in participants with metabolically healthy overweight at baseline (HR ranged from 1.95 to 4.62; p < 0.05 for all).ConclusionThe transition from baseline metabolically healthy status to unhealth status was associated with high risk of incident CAP.
Highlights
The presence of atherosclerosis obviously contributes to many adverse events, such as ischemic stroke, myocardial infarction, and impairment of cognitive function [1,2,3]
We performed a sequential recruitment. We excluded those with self-reported history of a series of metabolic diseases (n = 9622) and cancer (n = 29); Second, we excluded those with baseline metabolic abnormalities (n = 65,630); Third, we excluded those lost to follow up (2014–2018) (n = 13,378) and with missing data (n = 8083); we excluded those with low baseline BMI (≤ 18.4 kg/m2) (n = 2674); (6) aged 65 years or more because there were only 79 participants. (7) with carotid artery plaque (CAP) at baseline (n = 78); (8) with low estimated glomerular filatration rate (eGFR) < 60 ml/min/1.73m2 (n = 1)
Compared to those who remained metabolically healthy status, we found that transition to high blood pressure, high Total cholesterol (TC), and high low-density lipoprotein cholesterols (LDL-C) during follow up were associated a high likelihood of developing CAP, regardless of baseline body weight status (Table 3)
Summary
The presence of atherosclerosis obviously contributes to many adverse events, such as ischemic stroke, myocardial infarction, and impairment of cognitive function [1,2,3]. The effects of the transition from metabolically healthy status to metabolic abnormalities on the development of atherosclerosis were neglected among previous studies. To the best of our knowledge, only one cohort study to date evaluated the association of transition from metabolically healthy to unhealthy status with the development of atherosclerosis [23]. It has been doubtful to classify individuals with one metabolic risk factors, such as high blood pressure or impaired glucose regulation, as metabolically healthy status [5]. Different metabolic abnormalities might exert different effects on the developing atherosclerosis, it is appropriate to evaluate these risk factors (such as high blood pressure, impaired glucose regulation) separately rather than combining them together [24]
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