TY - JOUR
T1 - Association of Metabolic Phenotypes With Coronary Artery Disease and Cardiovascular Events in Patients With Stable Chest Pain
AU - PROMISE Investigators
AU - Kammerlander, Andreas A.
AU - Mayrhofer, Thomas
AU - Ferencik, Maros
AU - Pagidipati, Neha J.
AU - Karady, Julia
AU - Ginsburg, Geoffrey S.
AU - Lu, Michael T.
AU - Bittner, Daniel O.
AU - Puchner, Stefan B.
AU - Bihlmeyer, Nathan A.
AU - Meyersohn, Nandini M.
AU - Emami, Hamed
AU - Shah, Svati H.
AU - Douglas, Pamela S.
AU - Hoffmann, Udo
N1 - Publisher Copyright:
© 2021 by the American Diabetes Association.
PY - 2021/4
Y1 - 2021/4
N2 - OBJECTIVE Obesity and metabolic syndrome are associated with major adverse cardiovascular events (MACE). However, whether distinct metabolic phenotypes differ in risk for coronary artery disease (CAD) and MACE is unknown. We sought to determine the association of distinct metabolic phenotypes with CAD and MACE. RESEARCH DESIGN AND METHODS We included patients from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) who underwent coronary computed tomography (CT) angiography. Obesity was defined as a BMI ‡30 kg/m2 and metabolically healthy as less than or equal to one metabolic syndrome component except diabetes, distinguishing four metabolic phenotypes: metabolically healthy/ unhealthy and nonobese/obese (MHN, MHO, MUN, and MUO). Differences in severe calcification (coronary artery calcification [CAC] ‡400), severe CAD (‡70% stenosis), high-risk plaque (HRP), and MACE were assessed using adjusted logistic and Cox regression models. RESULTS Of 4,381 patients (48.4% male, 60.5 6 8.1 years of age), 49.4% were metabolically healthy (30.7% MHN and 18.7% MHO) and 50.6% unhealthy (22.3% MUN and 28.4% MUO). MHO had similar coronary CT findings as compared with MHN (severe CAC/ CAD and HRP; P > 0.36 for all). Among metabolically unhealthy patients, those with obesity had similar CT findings as compared with nonobese (P > 0.10 for all). However, both MUN and MUO had unfavorable CAD characteristics as compared with MHN (P £ 0.017 for all). A total of 130 events occurred during follow-up (median 26 months). Compared with MHN, MUN (hazard ratio [HR] 1.61 [95% CI 1.02–2.53]) but not MHO (HR 1.06 [0.62–1.82]) or MUO (HR 1.06 [0.66–1.72]) had higher risk for MACE. CONCLUSIONS In patients with stable chest pain, four metabolic phenotypes exhibit distinctly different CAD characteristics and risk for MACE. Individuals who are metabolically unhealthy despite not being obese were at highest risk in our cohort.
AB - OBJECTIVE Obesity and metabolic syndrome are associated with major adverse cardiovascular events (MACE). However, whether distinct metabolic phenotypes differ in risk for coronary artery disease (CAD) and MACE is unknown. We sought to determine the association of distinct metabolic phenotypes with CAD and MACE. RESEARCH DESIGN AND METHODS We included patients from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) who underwent coronary computed tomography (CT) angiography. Obesity was defined as a BMI ‡30 kg/m2 and metabolically healthy as less than or equal to one metabolic syndrome component except diabetes, distinguishing four metabolic phenotypes: metabolically healthy/ unhealthy and nonobese/obese (MHN, MHO, MUN, and MUO). Differences in severe calcification (coronary artery calcification [CAC] ‡400), severe CAD (‡70% stenosis), high-risk plaque (HRP), and MACE were assessed using adjusted logistic and Cox regression models. RESULTS Of 4,381 patients (48.4% male, 60.5 6 8.1 years of age), 49.4% were metabolically healthy (30.7% MHN and 18.7% MHO) and 50.6% unhealthy (22.3% MUN and 28.4% MUO). MHO had similar coronary CT findings as compared with MHN (severe CAC/ CAD and HRP; P > 0.36 for all). Among metabolically unhealthy patients, those with obesity had similar CT findings as compared with nonobese (P > 0.10 for all). However, both MUN and MUO had unfavorable CAD characteristics as compared with MHN (P £ 0.017 for all). A total of 130 events occurred during follow-up (median 26 months). Compared with MHN, MUN (hazard ratio [HR] 1.61 [95% CI 1.02–2.53]) but not MHO (HR 1.06 [0.62–1.82]) or MUO (HR 1.06 [0.66–1.72]) had higher risk for MACE. CONCLUSIONS In patients with stable chest pain, four metabolic phenotypes exhibit distinctly different CAD characteristics and risk for MACE. Individuals who are metabolically unhealthy despite not being obese were at highest risk in our cohort.
UR - http://www.scopus.com/inward/record.url?scp=85103306816&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85103306816&partnerID=8YFLogxK
U2 - 10.2337/DC20-1760
DO - 10.2337/DC20-1760
M3 - Article
C2 - 33558267
AN - SCOPUS:85103306816
SN - 0149-5992
VL - 44
SP - 1038
EP - 1045
JO - Diabetes care
JF - Diabetes care
IS - 4
ER -