Influence of the definition of "metabolically healthy obesity" on the progression of coronary artery calcification

• Published in: PloS one 2017-06, Vol.12 (6), p.e0178741-e0178741
• Main Authors: Yoon, Ji Won, Jung, Chan-Hyeon, Kim, Min-Kyung, Park, Hyo Eun, Park, Kyong Soo, Jang, Hak Chul, Moon, Min Kyong, Choi, Su-Yeon, Koo, Bo Kyung
• Format: Article
• Language: English
• Subjects: Adult; Anthropometry; Arteriosclerosis; Biology and Life Sciences; Biomarkers; Blood Pressure; Body mass; Calcification; Calcification (ectopic); Calcinosis - complications; Calcinosis - diagnostic imaging; Calcinosis - physiopathology; Calcium; Calcium - analysis; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Confidence intervals; Coronary artery; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary heart disease; Development and progression; Disease Progression; Female; Group dynamics; Health risks; Humans; Incidence; Laboratories; Lipids - blood; Male; Medicine and Health Sciences; Metabolic syndrome; Metabolic Syndrome - epidemiology; Middle Aged; Multidetector Computed Tomography; Obesity; Obesity, Metabolically Benign - complications; Phenotype; Physicians; Physiological aspects; Research and Analysis Methods; Retrospective Studies; Risk; Stability; Tomography
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0178741

Debates whether metabolically healthy obesity (MHO) increases the cardiovascular risk might be due to the metabolic instability of MHO or the absence of a perfect definition of MHO. Therefore, we aimed to investigate the influence of the MHO phenotype on the coronary artery calcium score (CACS) progression according to definition of MHO. We analyzed a retrospective cohort with a CACS of 0 at baseline and available serial CACS measurements taken ≥ 12 months apart (n = 1,218). Obesity was defined as BMI ≥ 25 kg/m2, and MHO was defined as obesity accompanied by ≤ 1 (MHO class I) or 0 (MHO class II) components of metabolic syndrome (MetS). During a median follow-up of 45 months, 32.2% of MHO class I and 10.2% of MHO class II subjects developed MetS. Compared to non-obese/metabolically healthy subjects (reference group), hazard ratios (HR) for development of MetS were 2.174 (95% confidence interval [CI]: 1.513-3.124) and 1.166 (95% CI: 0.434-3.129) for MHO class I and II subjects, respectively. The MHO class I subjects showed a significantly increased risk of CACS progression as compared to the reference group (HR: 1.653; 95% CI: 1.144-2.390), whereas MHO class II subjects did not (HR: 1.195; 95% CI: 0.514-2.778). Among subjects with MHO class I, no significant CACS progression was observed in the subjects who maintained metabolic health during follow-up (HR: 1.448; 95% CI: 0.921-2.278). The risks of metabolic deterioration and CACS progression were significant in subjects with MHO class I, but not in those with MHO class II.