Different metabolic phenotypes of obesity and risk of peripheral artery disease: A cohort study

Obesity has been considered as a risk factor for peripheral artery disease (PAD), but the impact of obesity combined with or without metabolic abnormality on risk of PAD remains unclear. This study aimed to explore the association between different metabolic phenotypes of obesity and PAD risk.

This study included 5440 participants without PAD at baseline. Metabolically healthy obesity (MHO) definition 1 was defined as body mass index (BMI)≥30 kg/m² without any metabolic syndrome (MetS) components, and MHO definition 2-3 were conducted for other conditions characterizing metabolic phenotypes. Cox proportional hazards regression model was established to investigate the associations between obesity with different metabolic parameters and PAD risk. During a mean follow-up of 15.6 years, 543 participants had incident PAD. Compared with participants with metabolic healthy normal weight, MHO participants did not show significantly higher risk of incident PAD without or with chronic limb ischemia, and obesity with unhealthy metabolic profile had the highest significant risk of incident PAD, with hazard ratios ranging from 1.702 (1.273-2.276) to 1.740 (1.316-2.301) (depend on MHO definition 1-3). Additionally, per 1 kg/m² increase of BMI was associated with a higher risk of PAD in metabolic unhealthy groups, and increasing of MetS components had an elevated risk of PAD, regardless of BMI status.

While MHO did not demonstrate a significant association with increased PAD risk, metabolically unhealthy obesity was associated with a markedly elevated risk of PAD events.