Beyond obesity: metabolic status as a key driver for cardiovascular outcomes in patients undergoing invasive coronary
Eva Steinacher1, Andreas Hammer1, Ulrike Baumer1
1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Insights
Metabolic health, not obesity, is crucial for preventing adverse cardiovascular events in patients with chronic coronary syndrome. Prioritizing metabolic profiling over BMI improves risk assessment and personalized treatment strategies.
Area of Science:
- Cardiology
- Metabolic Health
- Obesity Research
Background:
- Metabolic disorders and obesity are known risk factors for coronary artery disease (CAD) and major adverse cardiovascular events (MACE).
- The independent role of obesity as a cardiovascular risk modifier in metabolically healthy individuals, especially those with CAD, requires further investigation.
Purpose of the Study:
- To investigate the risk profiles associated with different metabolic phenotypes in patients undergoing invasive coronary angiography (ICA).
- To determine whether metabolic health or obesity is a stronger predictor of cardiovascular outcomes in patients with chronic coronary syndrome (CCS).
Main Methods:
- A cohort of 12,760 patients evaluated for CCS were categorized into four metabolic phenotypes: metabolically healthy non-obese (MHN), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUN), and metabolically unhealthy obese (MUO).
- Cox regression models, adjusted for age, sex, and renal dysfunction, were used to assess the association between metabolic phenotypes and outcomes like MACE, all-cause mortality, and revascularization.
Main Results:
- The study found that metabolic phenotypes significantly influenced risks for MACE, mortality, and revascularization.
- Metabolic disease was a robust predictor of adverse events, whereas obesity alone was not a significant independent predictor (e.g., MHO vs. MHN: adj. HR 0.947; MUO vs. MUN: adj. HR 0.974).
- Interestingly, metabolically healthy individuals exhibited lower event rates as their body mass index (BMI) increased, suggesting an obesity paradox.
Conclusions:
- Metabolic health is a more critical predictor of adverse cardiovascular events in CCS prevention than obesity.
- Cardiovascular risk assessment should emphasize metabolic health status over BMI.
- Integrating metabolic profiling into routine clinical evaluations can enhance prevention and personalize treatment strategies for patients with CCS.
Aims:
Metabolic disorders are established risk factors for coronary artery disease (CAD) and major adverse cardiovascular events (MACEs). Although obesity is closely associated with metabolic disease, data on its role as a separate cardiovascular risk modifier in metabolically healthy (MH) individuals are limited, particularly in patients with CAD. Thus, this study aims to investigate risk profiles of metabolic phenotypes on outcomes in patients undergoing invasive coronary angiography.
Methods And Results:
A total of 12 760 patients evaluated for chronic coronary syndrome (CCS) were distinguished into four metabolic phenotypes: MH/metabolically unhealthy (MU) non-obese/obese (MHN, MHO, MUN, and MUO). The association of metabolic phenotypes with outcome was assessed using Cox regression models, adjusted for age, sex, and renal dysfunction. Within the total study cohort (median age 68 years, 57.3% male), 56.5% presented MH (43.3% MHN; 13.1% MHO) and 43.5% MU (28.3% MUN; 15.2% MUO). Irrespective of CCS, metabolic phenotypes showed different risks for MACE, all-cause mortality, and revascularization. While metabolic disease emerged as a robust predictor of events, obesity alone did not [e.g. in patients with obstructive CCS: MHO vs. MHN: adj. hazard ratio (HR) 0.947, 95% confidence interval (CI) 0.728-1.231, P = 0.683; MUO vs. MUN: adj. HR 0.974 (95% CI 0.809-1.172), P = 0.780]. However, MH individuals experienced lower event rates with increasing body mass index (BMI).
Conclusion:
This study indicates metabolic health, rather than obesity, is a key predictor of adverse events in CCS prevention, revealing an obesity paradox in MH individuals. Thus, cardiovascular risk assessment should prioritize metabolic health over BMI. Integrating metabolic profiling into routine evaluations may help optimize prevention and personalized treatment strategies.
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