Influence of obesity and metabolic disease on carotid atherosclerosis in patients with coronary artery disease (CordioPrev study)

Authors: TALAVERA-GARCIA, EVA - Universidad De Cordoba; DELGADO-LISTA, JAVIER - Universidad De Cordoba; GARCIA-RIOS, ANTONIO - Universidad De Cordoba; DELGADO-CASADO, NIEVES - Universidad De Cordoba; GOMEZ-LUNA, PURIFICACION - Universidad De Cordoba; GOMEZ-GARDUÑO, ANGELA - Universidad De Cordoba; GOMEZ-DELGADO, FRANCISCO - Universidad De Cordoba; ALCALA-DIAZ, JUAN - Universidad De Cordoba; YUBERO-SERRANO, ELENA - Universidad De Cordoba; MARIN, CARMEN - Universidad De Cordoba; PEREZ-CABALLERO, ANA - Universidad De Cordoba; FUENTES-JIMENEZ, FRANCISCO - Universidad De Cordoba; CAMARGO, ANTONIO - Universidad De Cordoba; RODRIGUEZ-CANTALEJO, FERNANDO - University Hospital Reina Sofia; TINAHONES, FRANCISCO - Hospital Universitario Virgen De La Victoria; ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; PEREZ- JIMENEZ, FRANCISCO - Universidad De Cordoba; PEREZ-MARTINEZ, PABLO - Universidad De Cordoba; LOPEZ-MIRANDA, JOSE - Universidad De Cordoba

Submitted to: PLOS ONE
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/23/2016
Publication Date: 4/11/2016
Citation: Talavera-Garcia, E., Delgado-Lista, J., Garcia-Rios, A., Delgado-Casado, N., Gomez-Luna, P., Gomez-Garduño, A., Gomez-Delgado, F., Alcala-Diaz, J.F., Yubero-Serrano, E., Marin, C., Perez-Caballero, A.I., Fuentes-Jimenez, F.J., Camargo, A., Rodriguez-Cantalejo, F., Tinahones, F.J., Ordovas, J.M., Perez- Jimenez, F., Perez-Martinez, P., Lopez-Miranda, J. 2016. Influence of obesity and metabolic disease on carotid atherosclerosis in patients with coronary artery disease (CordioPrev study). PLoS One. doi: 10.1371/journal.pone.0157213.

Interpretive Summary: Traditionally, overweight and obesity have been defined based on body mass index (BMI); however, this classification does not reflect the metabolic status of the individual. Thus, there may be obese individuals who are metabolically healthy and, conversely, lean people who are metabolically compromised. The ability to classify people according to more precise measures will allow for a better prediction of cardiovascular risk. Towards that aim we determined the influence of isolated overweight and obesity on carotid intima media thickness (IMT-CC: a non-invasive measure of cardiovascular disease progression) and also assessed whether this influence was determined by the presence of metabolic abnormalities. We did that in 1,002 participants from the CordioPrev study. Our data show that metabolically sick participants (defined by the presence of two or more metabolic abnormalities) had a greater IMT-CC than metabolically healthy individuals. Overweight and normal weight patients who were metabolically healthy had a lower IMT-CC than the metabolically abnormal groups. When we evaluated only body weight, overweight, or obese patients did not differ significantly from normal-weight patients in their IMT-CC. Therefore, in coronary patients, a metabolically abnormal phenotype is associated with a greater IMT-CC and may be linked to a higher risk of suffering new cardiovascular events. However, it is still important to maintain or return to a healthy body weight.

Technical Abstract: Background: Recent data suggest that the presence of associated metabolic abnormalities may be important modifiers of the association of obesity with a poorer prognosis in coronary heart disease. We determined the influence of isolated overweight and obesity on carotid intima media thickness (IMT-CC), and also assessed whether this influence was determined by the presence of metabolic abnormalities. Methods: 1002 participants from the CordioPrev study were studied at entry. We determined their metabolic phenotypes and performed carotid ultrasound assessment. We evaluated the influence of obesity, overweight and metabolic phenotypes on the IMT-CC. Results: Metabolically sick participants (defined by the presence of two or more metabolic abnormalities) showed a greater IMT-CC than metabolically healthy individuals (p = 4 x 10(-6)). Overweight and normal weight patients who were metabolically healthy showed a lower IMT-CC than the metabolically abnormal groups (all p<0.05). When we evaluated only body weight (without considering metabolic phenotypes), overweight or obese patients did not differ significantly from normal-weight patients in their IMT-CC (p = 0.077). However, obesity was a determinant of IMT-CC when compared to the composite group of normal weight and overweight patients (all not obese). Conclusions: In coronary patients, a metabolically abnormal phenotype is associated with a greater IMT-CC, and may be linked to a higher risk of suffering new cardiovascular events. The protection conferred in the IMT-CC by the absence of metabolic abnormality may be blunted by the presence of obesity.