Author + information
- Received December 11, 2013
- Revision received February 10, 2014
- Accepted March 9, 2014
- Published online June 24, 2014.
- Yoosoo Chang, MD∗,†,
- Bo-Kyoung Kim, MD∗,
- Kyung Eun Yun, MD, PhD∗,
- Juhee Cho, PhD‡,§,
- Yiyi Zhang, PhD‡,
- Sanjay Rampal, MD‡,‖,
- Di Zhao, MHS‡,
- Hyun-Suk Jung, MD∗,
- Yuni Choi, BS∗,
- Jiin Ahn, MSPH∗,
- João A.C. Lima, MD¶,
- Hocheol Shin, MD, PhD#,
- Eliseo Guallar, MD, DrPH‡ and
- Seungho Ryu, MD, PhD∗,†∗ ()
- ∗Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
- †Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
- ‡Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- §Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- ‖Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- ¶Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- #Department of Family Medicine, Kangbuk Samsung Hospital and Sungkyunkwan University School of Medicine, Seoul, South Korea
- ↵∗Reprint requests and correspondence:
Dr. Seungho Ryu, Kangbuk Samsung Hospital, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul 100-742, South Korea.
Objectives The purpose of this study was to compare the coronary artery calcium (CAC) scores of metabolically-healthy obese (MHO) and metabolically healthy normal-weight individuals in a large sample of apparently healthy men and women.
Background The risk of cardiovascular disease among obese individuals without obesity-related metabolic abnormalities, referred to as MHO, is controversial.
Methods We conducted a cross-sectional study of 14,828 metabolically-healthy adults with no known cardiovascular disease who underwent a health checkup examination that included estimation of CAC scores by cardiac tomography. Being metabolically healthy was defined as not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5.
Results MHO individuals had a higher prevalence of coronary calcification than normal weight subjects. In multivariable-adjusted models, the CAC score ratio comparing MHO with normal-weight participants was 2.26 (95% confidence interval: 1.48 to 3.43). In mediation analyses, further adjustment for metabolic risk factors markedly attenuated this association, which was no longer statistically significant (CAC score ratio 1.24; 95% confidence interval: 0.79 to 1.96). These associations did not differ by clinically-relevant subgroups.
Conclusions MHO participants had a higher prevalence of subclinical coronary atherosclerosis than metabolically-healthy normal-weight participants, which supports the idea that MHO is not a harmless condition. This association, however, was mediated by metabolic risk factors at levels below those considered abnormal, which suggests that the label of metabolically healthy for obese subjects may be an artifact of the cutoff levels used in the definition of metabolic health.
- cardiovascular disease
- coronary artery calcium score
- coronary artery disease
- metabolically-healthy obesity
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Chang and Kim contributed equally to this work. Stephen Nicholls, MBBS, PhD, served as Guest Editor for this paper.
- Received December 11, 2013.
- Revision received February 10, 2014.
- Accepted March 9, 2014.
- American College of Cardiology Foundation