Won Ki-Bum, Choi Su-Yeon, Chun Eun Ju, Park Sung Hak, Sung Jidong, Jung Hae Ok, Chang Hyuk-Jae
Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea.
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea.
J Clin Med. 2023 May 31;12(11):3770. doi: 10.3390/jcm12113770.
Metabolically healthy obesity (MHO) is known to have a close association with subclinical coronary atherosclerosis. Despite recent data on the benefit of intensive systolic blood pressure (SBP) control in diverse clinical conditions, little is known regarding the association of normal SBP maintenance (SBP) with coronary artery calcification (CAC) progression in MHO. This study included 2724 asymptomatic adults (48.8 ± 7.8 years; 77.9% men) who had no metabolic abnormalities except overweight and obesity. Participants with normal weight (44.2%), overweight (31.6%), and obesity (24.2%) were divided into two groups: normal SBP (follow-up SBP < 120 mm Hg) and ≥elevated SBP (follow-up SBP ≥ 120 mm Hg). CAC progression was defined using the SQRT method, a difference of ≥2.5 between the square root (√) of the baseline and follow-up coronary artery calcium score. During a mean follow-up of 3.4 years, the proportion of normal SBP (76.2%, 65.2%, and 59.1%) and the incidence of CAC progression (15.0%, 21.3%, and 23.5%) was different in participants with normal weight, overweight, and obesity (all < 0.05, respectively). The incidence of CAC progression was lower in the normal SBP group than in the ≥elevated SBP group in only participants with obesity (20.8% vs. 27.4%, = 0.048). In multiple logistic models, compared to participants with normal weight, those with obesity had a higher risk of CAC progression. Normal SBP was independently associated with the decreased risk of CAC progression in participants with obesity. MHO had a significant association with CAC progression. Normal SBP reduced the risk of CAC progression in asymptomatic adults with MHO.
代谢健康型肥胖（MHO）与亚临床冠状动脉粥样硬化密切相关。尽管近期有数据表明在不同临床情况下强化收缩压（SBP）控制有益，但关于MHO患者维持正常SBP与冠状动脉钙化（CAC）进展之间的关联却知之甚少。本研究纳入了2724名无症状成年人（48.8±7.8岁；77.9%为男性），他们除超重和肥胖外无代谢异常。体重正常者（44.2%）、超重者（31.6%）和肥胖者（24.2%）被分为两组：正常SBP组（随访SBP<120mmHg）和SBP升高组（随访SBP≥120mmHg）。CAC进展采用SQRT方法定义，即基线和随访冠状动脉钙化积分的平方根（√）之差≥2.5。在平均3.4年的随访期间，体重正常、超重和肥胖参与者的正常SBP比例（分别为76.2%、65.2%和59.1%）以及CAC进展发生率（分别为15.0%、21.3%和23.5%）存在差异（均P<0.05）。仅在肥胖参与者中，正常SBP组的CAC进展发生率低于SBP升高组（20.8%对27.4%，P=0.048）。在多因素逻辑模型中，与体重正常的参与者相比，肥胖者发生CAC进展的风险更高。正常SBP与肥胖参与者CAC进展风险降低独立相关。MHO与CAC进展显著相关。正常SBP降低了MHO无症状成年人CAC进展的风险。
