Coronary artery disease risk among obese metabolically healthy young men

Gilad Twig; Hertzel C Gerstein; Dana Ben-Ami Shor; Estela Derazne; Dorit Tzur; Arnon Afek; Amir Tirosh

doi:10.1530/EJE-15-0284

Coronary artery disease risk among obese metabolically healthy young men

Eur J Endocrinol. 2015 Sep;173(3):305-12. doi: 10.1530/EJE-15-0284. Epub 2015 Jun 3.

Authors

Gilad Twig¹, Hertzel C Gerstein², Dana Ben-Ami Shor², Estela Derazne³, Dorit Tzur², Arnon Afek³, Amir Tirosh¹

Affiliations

¹ Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham
² Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³ Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.

PMID: 26041076
DOI: 10.1530/EJE-15-0284

Abstract

Objective: The aim of this study was to assess coronary artery disease (CAD) risk among obese young men without metabolic risk factors.

Design: A longitudinal study in a historical cohort.

Methods: Incident CAD during a median follow-up of 6.1 years was assessed among 31,684 young men (mean age 31.2 ± 5.7 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults (MELANY) cohort. Participants were categorized by BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ≥ 30 kg/m(2) in the presence of normal blood pressure (BP) and normal levels of fasting glucose, triglyceride, and HDL-cholesterol (HDL-c) levels (n = 599; 1.9%). Cox proportional hazard models were applied.

Results: There were 198 new cases of CAD that were diagnosed during 209,971 person-years of follow-up, of which six cases occurred among MH obese. The incidence of CAD among MH lean, overweight, and obese participants was 0.23, 0.45, and 1.0/1000 person-years respectively. In a multivariable model adjusted for clinical and biochemical CAD risk factors, a higher CAD risk was observed among MH-obese (hazard ratio = 3.08; 95% CI = 1.10-8.68, P = 0.033), compared to MH-normal weight subjects. This risk persisted when BMI was treated as a time-dependent variable, or when fasting glucose, HDL-c, triglycerides, or BP were added to the model. Similar results were also obtained when a more permissive definition of MH was used.

Conclusions: Obesity may continue to contribute to increased risk for incident CAD in young men even in the presence of a healthy metabolic profile.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Glucose
Blood Pressure
Cholesterol, HDL / blood
Cohort Studies
Coronary Artery Disease / blood
Coronary Artery Disease / epidemiology*
Humans
Incidence
Longitudinal Studies
Male
Multivariate Analysis
Obesity / blood
Obesity / epidemiology*
Overweight / blood
Overweight / epidemiology
Proportional Hazards Models
Triglycerides / blood

Substances

Blood Glucose
Cholesterol, HDL
Triglycerides