Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2013 Sep 11;8(9):e74564. doi: 10.1371/journal.pone.0074564. eCollection 2013.
Recent studies have suggested that metabolic health may contribute more to the atherosclerosis than obesity. The aim of this study is to compare coronary artery calcium scores (CACS) among patients with different metabolic health and obesity status.
A health-screening program of 24,063 participants (mean age 41 years) was conducted, and CACS was assessed by multi-detector computerized tomography (MDCT). Being metabolically healthy was defined as having fewer than two of the following risk factors: high blood pressure, high fasting blood glucose, high triglyceride, low high-density lipoprotein cholesterol, highest decile of homeostasis model assessment-insulin resistance (HOMA-IR) index, and highest decile of high-sensitivity C-reactive protein (hs-CRP). Obesity status was defined as body mass index (BMI) higher than 25 kg/m(2). Analyses were performed in four groups divided according to metabolic health and obesity: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUHNO), and metabolically unhealthy obese (MUHO).
Mean values of CACS in the four groups were significantly different, except those between MHNO and MHO and between MUHNO and MUHO. When multinomial logistic regression analysis was performed with five CACS categories as the dependent variables and after adjusting for age, sex, and smoking status, the MHO, MUHNO, and MUHO groups showed significantly increased odds ratio for increasing CACS categories compared with no calcification status (5.221 for CACS >400 in MUHO group with 95% CI 2.856∼5.032 with MHNO group as the reference). When other variables including the metabolic parameters were included in the same model, the risks were attenuated.
Metabolic health is more closely associated with subclinical atherosclerosis than obesity as assessed by CACS.
最近的研究表明，代谢健康对动脉粥样硬化的贡献可能大于肥胖。本研究旨在比较不同代谢健康和肥胖状态患者的冠状动脉钙评分（CACS）。
对 24063 名参与者（平均年龄 41 岁）进行健康筛查计划，并通过多探测器计算机断层扫描（MDCT）评估 CACS。代谢健康定义为以下危险因素少于两个：高血压、空腹血糖高、甘油三酯高、高密度脂蛋白胆固醇低、稳态模型评估胰岛素抵抗（HOMA-IR）指数最高十分位数和高敏 C 反应蛋白（hs-CRP）最高十分位数。肥胖状态定义为体重指数（BMI）高于 25kg/m2。根据代谢健康和肥胖状况将参与者分为四组进行分析：代谢健康非肥胖（MHNO）、代谢健康肥胖（MHO）、代谢不健康非肥胖（MUHNO）和代谢不健康肥胖（MUHO）。
四组的 CACS 平均值差异有统计学意义，除 MHNO 和 MHO 之间以及 MUHNO 和 MUHO 之间外。当以 CACS 五分位作为因变量，进行多分类逻辑回归分析，并调整年龄、性别和吸烟状况后，与无钙化状态相比，MHO、MUHNO 和 MUHO 组的 CACS 五分位增加的比值比显著增加（MUHO 组 CACS>400 的比值比为 5.221，95%CI 为 2.856∼5.032，以 MHNO 组为参照）。当将其他变量包括代谢参数纳入同一模型时，风险有所减弱。
与肥胖相比，CACS 评估的代谢健康与亚临床动脉粥样硬化的关系更为密切。
