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Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Coronary artery disease risk among obese metabolically healthy young men
Gilad Twig1, Hertzel C Gerstein2, Dana Ben-Ami Shor2
1Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham
Insights
Obese young men without metabolic risk factors still face increased coronary artery disease (CAD) risk. This study highlights that even metabolically healthy obesity elevates CAD risk in this demographic.
Area of Science:
- Cardiology
- Metabolic Health
- Public Health
Background:
- Obesity is a growing concern in young adults.
- The link between obesity and cardiovascular disease is well-established.
- However, the risk associated with metabolically healthy obesity (MHO) in young men is less understood.
Purpose of the Study:
- To evaluate the association between MHO and incident coronary artery disease (CAD) in young men.
- To determine if MHO confers an increased risk of CAD independent of traditional risk factors.
Main Methods:
- A longitudinal cohort study of 31,684 young men from the MELANY cohort.
- Participants were classified by Body Mass Index (BMI) and metabolic health status (Adult Treatment Panel-III criteria).
- Cox proportional hazard models were used to assess CAD risk over a median follow-up of 6.1 years.
Main Results:
- Metabolically healthy obesity (MHO) was identified in 1.9% of participants.
- A significantly higher risk of incident CAD was observed in MH-obese men (HR=3.08) compared to metabolically healthy normal-weight men.
- This association remained significant after adjusting for multiple CAD risk factors.
Conclusions:
- Obesity may increase the risk of coronary artery disease in young men, even without other metabolic abnormalities.
- Metabolically healthy obesity represents a significant risk factor for future cardiovascular events in young men.
- These findings underscore the importance of weight management for cardiovascular health in young men.
Objective:
The aim of this study was to assess coronary artery disease (CAD) risk among obese young men without metabolic risk factors.
Design:
A longitudinal study in a historical cohort.
Methods:
Incident CAD during a median follow-up of 6.1 years was assessed among 31,684 young men (mean age 31.2 ± 5.7 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults (MELANY) cohort. Participants were categorized by BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ≥ 30 kg/m(2) in the presence of normal blood pressure (BP) and normal levels of fasting glucose, triglyceride, and HDL-cholesterol (HDL-c) levels (n = 599; 1.9%). Cox proportional hazard models were applied.
Results:
There were 198 new cases of CAD that were diagnosed during 209,971 person-years of follow-up, of which six cases occurred among MH obese. The incidence of CAD among MH lean, overweight, and obese participants was 0.23, 0.45, and 1.0/1000 person-years respectively. In a multivariable model adjusted for clinical and biochemical CAD risk factors, a higher CAD risk was observed among MH-obese (hazard ratio = 3.08; 95% CI = 1.10-8.68, P = 0.033), compared to MH-normal weight subjects. This risk persisted when BMI was treated as a time-dependent variable, or when fasting glucose, HDL-c, triglycerides, or BP were added to the model. Similar results were also obtained when a more permissive definition of MH was used.
Conclusions:
Obesity may continue to contribute to increased risk for incident CAD in young men even in the presence of a healthy metabolic profile.
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