肥胖的不同代谢表型与冠状动脉钙化进展及心血管疾病事件发生风险：CARDIA研究

Different Metabolic Phenotypes of Obesity and Risk of Coronary Artery Calcium Progression and Incident Cardiovascular Disease Events: The CARDIA Study.

作者信息

Gao Jing-Wei, You Si, Liu Zhao-Yu, Hao Qing-Yun, Wang Jing-Feng, Vuitton Dominique A, Zhang Shao-Ling, Liu Pin-Ming

机构信息

Department of Cardiology (J.-W.G., S.Y., Q.-Y.H., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

Medical Research Center (Z.-Y.L.), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

出版信息

Arterioscler Thromb Vasc Biol. 2022 May;42(5):677-688. doi: 10.1161/ATVBAHA.122.317526. Epub 2022 Apr 7.

DOI:10.1161/ATVBAHA.122.317526

PMID:35387482

Abstract

BACKGROUND

To investigate whether obesity with or without metabolic syndrome is prospectively associated with coronary artery calcium (CAC) progression and incident cardiovascular disease events.

METHODS

A total of 1730 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults) were included (age, 40.1±3.6 years; 38.3% men), who completed computed tomography of CAC at baseline (year 15: 2000-2001) and follow-up (year 20 or 25). Metabolically healthy obesity (MHO) was defined as body mass index≥30 kg/m without any metabolic syndrome components in our main analysis. Sensitivity analyses were conducted for several conditions characterizing 4 metabolic phenotypes.

RESULTS

During a mean follow-up of 9.1 years, 439 participants had CAC progression. MHO subjects had a significantly higher risk of CAC progression than their metabolically healthy normal weight counterparts (adjusted hazard ratios [95% CIs] from 1.761 [1.369-2.264] to 2.047 [1.380-3.036]) depending on the definition of MHO adopted. Obesity with unhealthy metabolic profile remained the highest significant risk of CAC progression and cardiovascular disease events whatever the definitions adopted for metabolically unhealthy status. Up to 60% of participants with MHO converted to metabolically unhealthy obesity from year 15 to year 20 or year 25. Further sensitivity analysis showed that MHO throughout carried a similar risk of incident cardiovascular disease events compared with metabolically healthy normal weight throughout.

CONCLUSIONS

Different metabolic phenotypes of obesity beginning at a young age exhibit distinct risks of CAC progression and subsequent cardiovascular disease events in later midlife. MHO represents an intermediate phenotype between metabolically low- to high-risk obese individuals.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT00005130.

摘要

背景

探讨伴有或不伴有代谢综合征的肥胖是否与冠状动脉钙化（CAC）进展及心血管疾病事件的发生存在前瞻性关联。

方法

纳入了来自CARDIA研究（青年成人冠状动脉风险发展研究）的1730名参与者（年龄40.1±3.6岁；男性占38.3%），他们在基线时（第15年：2000 - 2001年）以及随访时（第20年或第25年）完成了CAC的计算机断层扫描。在我们的主要分析中，代谢健康肥胖（MHO）被定义为体重指数≥30 kg/m²且无任何代谢综合征组分。针对表征4种代谢表型的几种情况进行了敏感性分析。

结果

在平均9.1年的随访期间，439名参与者出现了CAC进展。根据所采用的MHO定义，MHO受试者发生CAC进展的风险显著高于代谢健康的正常体重者（调整后的风险比[95%置信区间]从1.761[1.369 - 2.264]到2.047[1.380 - 3.036]）。无论对代谢不健康状态采用何种定义，伴有不健康代谢特征的肥胖始终是CAC进展和心血管疾病事件的最高显著风险因素。高达60%的MHO参与者在第15年到第20年或第25年期间转变为代谢不健康肥胖。进一步的敏感性分析表明，与始终代谢健康的正常体重者相比，始终处于MHO状态的参与者发生心血管疾病事件的风险相似。