Exploring Metabolic Obesity Phenotypes and Atherosclerotic Cardiovascular Disease Risk in Arab Adults

This study investigates the 10-year atherosclerotic cardiovascular disease (ASCVD) risk in different metabolic obesity phenotypes in Saudi adults. A cohort of 5460 adults (aged 40-79) was categorised based on metabolic status, body mass index (BMI), and visceral adiposity index (VAI). Using the ASCVD Risk Estimator Plus, the 10-year risk scores were calculated and explored in different metabolic phenotypes. Females showed higher obesity prevalence, while males had a higher metabolically unhealthy phenotype prevalence. Despite being considered healthy by traditional metrics, individuals with Metabolically Healthy Obesity (MHO) exhibited significantly higher ASCVD risk scores compared to Metabolically Healthy Normal Weight (MHNW) counterparts (2.44 vs. 1.34 in females, p < 0.001; 9.60 vs. 6.72 in males, p = 0.008). When obesity was defined by BMI, in men, MHO showed a substantially higher age-adjusted odds ratio (OR) for greater ASCVD risk than MHNW (OR = 2.04, 95% CI 1.3-3.3, p = 0.003). However, when obesity was characterised by VAI rather than BMI, ASCVD risk in metabolically healthy with high VAI (MHHV), equivalent to MHO, was similar to its normal VAI counterpart, independent of gender (OR = 0.92, 95% CI 0.7-1.2, p = 0.55 for females; OR = 1.23, 95% CI 0.9-1.7, p = 0.25 for men). The study provides insights into ASCVD risk in multiple metabolic and obesity phenotypes among Saudi individuals, indicating that VAI outperforms BMI in identifying the metabolically healthy obese phenotype.