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Cardiovascular risks according to metabolic phenotypes of patients admitted to an obesity outpatient clinic

Yıl 2021, Cilt: 26 Sayı: 1, 70 - 79, 30.01.2021

Burcu Güven Kacıroğlu Hacer Hicran Mutlu

https://doi.org/10.21673/anadoluklin.774351

Öz

Aim: Obesity is a condition that increases cardiovascular risk due to both the pro-inflammatory effect of increased adipose tissue and frequently associated diseases. The effect of metabolic healthy obesity on cardiovascular risk is controversial. In our study, we aimed to determine the cardiovascular risk profile according to the metabolic phenotype of the patients who applied to our obesity outpatient clinic using the plasma atherogenic index (PAI).


Materials and Methods: PAI was used to assess the cardiovascular risks of the participants. Those who do not have any metabolic syndrome criteria other than increased waist circumference (blood pressure≥130/85 mmHg, fasting blood sugar≥100 mg/dl, triglyceride≥150 mg/dl, HDL-K<40 mg/dl in men, <50 mg/dl in women or who used drugs lowering these parameters) were defined as metabolically healthy obese and those with any of these criteria were defined as metabolic unhealthy obese.


Results: Most of the participants (76.9%) were found to be in the group with high cardiovascular risk. The sociodemographic and anthropometric factors affecting cardiovascular risk appeared to be the body mass index (BMI), body fat and muscle amount, smoking habit, exercise habits and metabolic phenotype. It was found that 14.1% (n=137) of the patients were metabolically healthy and 85.9% (n=838) of them were metabolically unhealthy. Women had more metabolically healthy phenotypes than men (p=0.009). Metabolic unhealthy obese patients were older (p=0.006). Metabolically healthy obese people had lower BMI, body fat and muscle mass (p<0.001; p<0.001; p<0.001). PAI values of metabolically unhealthy obese individuals were significantly higher than those of metabolically healthy obese individuals (p<0.001).


Conclusion: It was concluded that most of the obese individuals were in the high cardiovascular risk group and the cardiovascular risk of metabolically unhealthy obese people was significantly higher than that of metabolic healthy obese people. The high amount of BMI and body fat of metabolically unhealthy individuals suggested that as the amount of BMI and fat increases, a transition may occur from metabolic healthiness to unhealthiness and the cardiovascular risk may increase over time.

Anahtar Kelimeler

Obesity metabolic syndrome cardiovascular system atherosclerosis

Kaynakça

  • Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis. 2018;61(2):142–50.
  • Iacobini C, Pugliese G, Fantauzzi CB, Federici M, Menini S. Metabolically healthy versus metabolically unhealthy obesity. Metabolism. 2019;92:51–60.
  • King RJ, Ajjan RA. Vascular risk in obesity : Facts, misconceptions and the unknown. Diab Vasc Dis Res. 2017;2–13.
  • Piché M, Poirier P, Lemieux I, Després J. Progress in cardiovascular diseases overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease : An update. Prog Cardiovasc Dis. 2018;61(2):103–13.
  • Andres R. Effect of obesity on total mortality. Int J Obes. 1980;4(4):381.
  • Sims EAH. Characterization of the syndromes of obesity. In: Brodoff BN, Bleicher SJ, editors. Diabetes Mellitus and Obesity. Williams & Wilkins; Baltimore, MD: 1982. pp. 219–226
  • Al-khalidi B, Kimball SM, Kuk JL, Ardern CI. Metabolically healthy obesity, vitamin D, and all-cause and cardiometabolic mortality risk in NHANES III. Clin Nutr. 2018;1–9.
  • Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, Sims EAH, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab. 2001;86(3):1020–5.
  • Kim TJ, Shin H-Y, Chang Y, Kang M, Jee J, Choi Y-H, et al. Metabolically healthy obesity and the risk for subclinical atherosclerosis. Atherosclerosis. 2017;262:191–7.
  • Mirzaei B, Abdi H, Serahati S, Barzin M, Niroomand M, Azizi F, et al. Cardiovascular risk in different obesity phenotypes over a decade follow-up : Tehran Lipid and Glucose Study. Atherosclerosis. 2017;258:65–71.
  • De Ycaza AEE, Donegan D, Jensen MD. Long-term metabolic risk for the metabolically healthy overweight/obese phenotype. Int J Obes. 2018;42(3):302–9.
  • Vecchié A, Dallegri F, Carbone F, Bonaventura A, Liberale L, Portincasa P, et al. European Journal of Internal Medicine Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med .2017;:0–1.
  • Kyung Y, Mi Y, Hee J, Lee J, Park J, Je W, et al. Implications of the dynamic nature of metabolic health status and obesity on risk of incident cardiovascular events and mortality : a nationwide population-based cohort study. Metabolism. 2019;97:50–6.
  • Nwagha UI, Ikekpeazu EJ, Ejezie FE, Neboh EE, Maduka I. Atherogenic index of plasma as useful predictor of cardiovascular risk among postmenopausal women in Enugu, Nigeria. Afr Health Sci. 2010;10(3).
  • Shen S, Lu Y, Qi H, Li F, Shen Z, Wu L, et al. Association between ideal cardiovascular health and the atherogenic index of plasma. Medicine (Baltimore). 2016;95(24).
  • Chang Y, Li Y, Guo X, Dai D, Sun Y. The Association of Ideal Cardiovascular Health and Atherogenic Index of Plasma in Rural Population: A Cross-Sectional Study from Northeast China. Int J Environ Res Public Health. 2016;13(10).
  • Fernández-Macías JC, Ochoa-Martínez AC, Varela-Silva JA, Pérez-Maldonado IN. Atherogenic Index of Plasma: Novel Predictive Biomarker for Cardiovascular Illnesses. Arch Med Res. 2019;50(5):285–94.
  • Hinnouho G-M, Czernichow S, Dugravot A, Batty GD, Kivimaki M, Singh-Manoux A. Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter? Diabetes Care. 2013;36(8):2294–300.
  • Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res. 2016;118(11):1752–70.
  • Wilson PWF, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience. Arch Intern Med.. 2002 Sep 9;162(16):1867–72.
  • Akoumianakis I, Akawi N, Antoniades C. Exploring the Crosstalk between Adipose Tissue and the Cardiovascular System. Korean Circ J. 2017/09/21. 2017;47(5):670–85.
  • Eckel N, Li Y, Kuxhaus O, Stefan N, Hu FB, Schulze MB. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women ( the Nurses ’ Health Study ): 30 year follow-up from a prospective cohort study. LANCET Diabetes Endocrinol 2018;6(9):714–24.
  • Wildman RP. Healthy obesity. Curr Opin Clin Nutr Metab Care. 2009;12(4):438–43.
  • Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012;97(7):2482–8.
  • Ogorodnikova AD, Kim M, McGinn AP, Muntner P, Khan U, Wildman RP. Incident cardiovascular disease events in metabolically benign obese individuals. Obesity. 2012;20(3):651–9.
  • Appleton SL, Seaborn CJ, Visvanathan R, Hill CL, Gill TK, Taylor AW, et al. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Diabetes Care. 2013;36(8):2388–94.
  • Valavanis IK, Mougiakakou SG, Grimaldi KA, Nikita KS. A multifactorial analysis of obesity as CVD risk factor: use of neural network based methods in a nutrigenetics context. BMC Bioinformatics. 2010;11(1):453.
  • Cercato C, Fonseca FA. Cardiovascular risk and obesity. Diabetol Metab Syndr. 2019;11(1):74
  • Hingorani AD, Finan C, Schmidt AF. Obesity causes cardiovascular diseases: adding to the weight of evidence. Eur Heart J. 2020;41(2):227–30.
  • Bhatnagar A. Environmental Determinants of Cardiovascular Disease. Circ Res. 2017:7;121(2):162–80.
  • Koster A, Leitzmann MF, Schatzkin A, Adams KF, van Eijk JTM, Hollenbeck AR, et al. The combined relations of adiposity and smoking on mortality. Am J Clin Nutr. 2008;88(5):1206–12.
  • iahpush M, Singh GK, Tibbits M, Pinard CA, Shaikh RA, Yaroch A. It is better to be a fat ex-smoker than a thin smoker: findings from the 1997–2004 National Health Interview Survey− National Death Index linkage study. Tob Control. 2014;23(5):395–402.
  • Channon KM. Exercise and cardiovascular health: new routes to reap more rewards. Cardiovasc Res. 2019;8;116(5):e56–8.
  • Liu Z, Que S, Xu J, Peng T. Alanine aminotransferase-old biomarker and new concept: a review. Int J Med Sci. 2014;11(9):925.
  • Lioudaki E, S Ganotakis E, P Mikhailidis D. Liver enzymes: potential cardiovascular risk markers? Curr Pharm Des. 2011;17(33):3632–43.
  • Martinez-Gomez D, Ortega FB, Hamer M, Lopez-Garcia E, Struijk E, Sadarangani KP, et al. Physical activity and risk of metabolic phenotypes of obesity: a prospective Taiwanese cohort study in more than 200,000 adults. In: Mayo Clinic Proceedings. Elsevier; 2019. p. 2209–19.
  • Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Arch Intern Med. 2008;168(15):1617–24.
  • Ortega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. 2016;1752–70.
  • Goday A, Calvo E, Vázquez LA, Caveda E, Margallo T, Catalina-Romero C, et al. Prevalence and clinical characteristics of metabolically healthy obese individuals and other obese/non-obese metabolic phenotypes in a working population: results from the Icaria study. BMC Public Health. 2016;16:248.

Obezite Polikliniğine Başvuran Hastaların Metabolik Fenotiplerine Göre Kardiyovasküler Riskleri

Yıl 2021, Cilt: 26 Sayı: 1, 70 - 79, 30.01.2021

Burcu Güven Kacıroğlu Hacer Hicran Mutlu

https://doi.org/10.21673/anadoluklin.774351

Öz

Amaç: Obezite, hem artan yağ dokusunun pro-inflamatuar etkisi, hem de sıklıkla birliktelik gösteren hastalıklar nedeniyle kardiyovasküler riski arttıran bir durumdur. Son zamanlarda metabolik sağlıklı obezitenin kardiyovasküler risk üzerine olan etkisi tartışmalıdır. Çalışmamızda, plazma aterojenik indeksi (PAİ) kullanılarak obezite polikliniğimize başvuran hastaların metabolik fenotipine göre kardiyovasküler risk profilini saptamak amaçlanmıştır.


Gereç ve Yöntemler: Katılımcıların kardiyovasküler riskini değerlendirmek için PAİ kullanıldı. Metabolik sendrom kriterlerinden bel çevresi artışı dışında herhangi bir metabolik sendrom kriterine sahip olmayanlar (kan basıncı≥130/85 mmHg, açlık kan şekeri≥100 mg/dl, trigliserit≥150 mg/dl, HDL-K erkeklerde<40 mg/dl, kadınlarda <50 mg/dl veya bu parametreleri düşürücü ilaç kullananlar) metabolik sağlıklı obez, bu kriterlerden herhangi birine sahip olanlar ise metabolik sağlıksız obez olarak tanımlandı.


Bulgular: Tüm katılımcıların PAİ ile kardiyovasküler riski değerlendirildiğinde %76,9’unun (n=722) yüksek kardiyovasküler riskli grupta olduğu ve kardiyovasküler riski etkileyen sosyodemografik ve antropometrik faktörlerin cinsiyet, vücut kütle indeksi (VKİ), vücut yağ ve kas miktarı, sigara içme alışkanlığı, egzersiz alışkanlığı ve metabolik fenotip olduğu görülmektedir. Katılımcıların metabolik fenotipleri incelendiğinde %14,1’inin (n=137) metabolik sağlıklı, %85,9’unın (n=838) metabolik sağlıksız olduğu saptanmıştır. Kadınlar, erkeklere göre daha çok metabolik sağlıklı fenotipine sahiptir (p=0,009). Metabolik sağlıksız obezlerin yaşı daha ileridir (p=0,006). Metabolik sağlıklı obezlerin VKİ, vücut yağ ve kas kütleleri daha düşüktür (sırasıyla p<0,001; p<0,001; p<0,001). Metabolik sağlıksız obez bireylerin PAİ değerleri metabolik sağlıklı obez bireylerden anlamlı olarak daha yüksektir (p<0,001).


Sonuç: Genel olarak değerlendirildiğinde obez bireylerin çoğunun yüksek kardiyovaküler riskli grupta olduğu, metabolik sağlıksız obez kişilerin kardiyovasküler riskinin metabolik sağlıklı obezlere göre anlamlı olarak daha yüksek olduğu sonucu çıkmıştır. Metabolik sağlıksız bireylerin VKI ve vücut yağ miktarlarının fazla olması, VKI ve yağ miktarı arttıkça metabolik sağlıklı bireylerin metabolik sağlıksızlığa doğru geçiş yapabileceği ve kardiyovasküler riskinin zamanla artabileceğini düşündürmüştür.

Anahtar Kelimeler

Obezite metabolik sendrom kardiyovasküler sistem ateroskleroz

Kaynakça

  • Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis. 2018;61(2):142–50.
  • Iacobini C, Pugliese G, Fantauzzi CB, Federici M, Menini S. Metabolically healthy versus metabolically unhealthy obesity. Metabolism. 2019;92:51–60.
  • King RJ, Ajjan RA. Vascular risk in obesity : Facts, misconceptions and the unknown. Diab Vasc Dis Res. 2017;2–13.
  • Piché M, Poirier P, Lemieux I, Després J. Progress in cardiovascular diseases overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease : An update. Prog Cardiovasc Dis. 2018;61(2):103–13.
  • Andres R. Effect of obesity on total mortality. Int J Obes. 1980;4(4):381.
  • Sims EAH. Characterization of the syndromes of obesity. In: Brodoff BN, Bleicher SJ, editors. Diabetes Mellitus and Obesity. Williams & Wilkins; Baltimore, MD: 1982. pp. 219–226
  • Al-khalidi B, Kimball SM, Kuk JL, Ardern CI. Metabolically healthy obesity, vitamin D, and all-cause and cardiometabolic mortality risk in NHANES III. Clin Nutr. 2018;1–9.
  • Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, Sims EAH, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab. 2001;86(3):1020–5.
  • Kim TJ, Shin H-Y, Chang Y, Kang M, Jee J, Choi Y-H, et al. Metabolically healthy obesity and the risk for subclinical atherosclerosis. Atherosclerosis. 2017;262:191–7.
  • Mirzaei B, Abdi H, Serahati S, Barzin M, Niroomand M, Azizi F, et al. Cardiovascular risk in different obesity phenotypes over a decade follow-up : Tehran Lipid and Glucose Study. Atherosclerosis. 2017;258:65–71.
  • De Ycaza AEE, Donegan D, Jensen MD. Long-term metabolic risk for the metabolically healthy overweight/obese phenotype. Int J Obes. 2018;42(3):302–9.
  • Vecchié A, Dallegri F, Carbone F, Bonaventura A, Liberale L, Portincasa P, et al. European Journal of Internal Medicine Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med .2017;:0–1.
  • Kyung Y, Mi Y, Hee J, Lee J, Park J, Je W, et al. Implications of the dynamic nature of metabolic health status and obesity on risk of incident cardiovascular events and mortality : a nationwide population-based cohort study. Metabolism. 2019;97:50–6.
  • Nwagha UI, Ikekpeazu EJ, Ejezie FE, Neboh EE, Maduka I. Atherogenic index of plasma as useful predictor of cardiovascular risk among postmenopausal women in Enugu, Nigeria. Afr Health Sci. 2010;10(3).
  • Shen S, Lu Y, Qi H, Li F, Shen Z, Wu L, et al. Association between ideal cardiovascular health and the atherogenic index of plasma. Medicine (Baltimore). 2016;95(24).
  • Chang Y, Li Y, Guo X, Dai D, Sun Y. The Association of Ideal Cardiovascular Health and Atherogenic Index of Plasma in Rural Population: A Cross-Sectional Study from Northeast China. Int J Environ Res Public Health. 2016;13(10).
  • Fernández-Macías JC, Ochoa-Martínez AC, Varela-Silva JA, Pérez-Maldonado IN. Atherogenic Index of Plasma: Novel Predictive Biomarker for Cardiovascular Illnesses. Arch Med Res. 2019;50(5):285–94.
  • Hinnouho G-M, Czernichow S, Dugravot A, Batty GD, Kivimaki M, Singh-Manoux A. Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter? Diabetes Care. 2013;36(8):2294–300.
  • Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res. 2016;118(11):1752–70.
  • Wilson PWF, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience. Arch Intern Med.. 2002 Sep 9;162(16):1867–72.
  • Akoumianakis I, Akawi N, Antoniades C. Exploring the Crosstalk between Adipose Tissue and the Cardiovascular System. Korean Circ J. 2017/09/21. 2017;47(5):670–85.
  • Eckel N, Li Y, Kuxhaus O, Stefan N, Hu FB, Schulze MB. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women ( the Nurses ’ Health Study ): 30 year follow-up from a prospective cohort study. LANCET Diabetes Endocrinol 2018;6(9):714–24.
  • Wildman RP. Healthy obesity. Curr Opin Clin Nutr Metab Care. 2009;12(4):438–43.
  • Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012;97(7):2482–8.
  • Ogorodnikova AD, Kim M, McGinn AP, Muntner P, Khan U, Wildman RP. Incident cardiovascular disease events in metabolically benign obese individuals. Obesity. 2012;20(3):651–9.
  • Appleton SL, Seaborn CJ, Visvanathan R, Hill CL, Gill TK, Taylor AW, et al. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Diabetes Care. 2013;36(8):2388–94.
  • Valavanis IK, Mougiakakou SG, Grimaldi KA, Nikita KS. A multifactorial analysis of obesity as CVD risk factor: use of neural network based methods in a nutrigenetics context. BMC Bioinformatics. 2010;11(1):453.
  • Cercato C, Fonseca FA. Cardiovascular risk and obesity. Diabetol Metab Syndr. 2019;11(1):74
  • Hingorani AD, Finan C, Schmidt AF. Obesity causes cardiovascular diseases: adding to the weight of evidence. Eur Heart J. 2020;41(2):227–30.
  • Bhatnagar A. Environmental Determinants of Cardiovascular Disease. Circ Res. 2017:7;121(2):162–80.
  • Koster A, Leitzmann MF, Schatzkin A, Adams KF, van Eijk JTM, Hollenbeck AR, et al. The combined relations of adiposity and smoking on mortality. Am J Clin Nutr. 2008;88(5):1206–12.
  • iahpush M, Singh GK, Tibbits M, Pinard CA, Shaikh RA, Yaroch A. It is better to be a fat ex-smoker than a thin smoker: findings from the 1997–2004 National Health Interview Survey− National Death Index linkage study. Tob Control. 2014;23(5):395–402.
  • Channon KM. Exercise and cardiovascular health: new routes to reap more rewards. Cardiovasc Res. 2019;8;116(5):e56–8.
  • Liu Z, Que S, Xu J, Peng T. Alanine aminotransferase-old biomarker and new concept: a review. Int J Med Sci. 2014;11(9):925.
  • Lioudaki E, S Ganotakis E, P Mikhailidis D. Liver enzymes: potential cardiovascular risk markers? Curr Pharm Des. 2011;17(33):3632–43.
  • Martinez-Gomez D, Ortega FB, Hamer M, Lopez-Garcia E, Struijk E, Sadarangani KP, et al. Physical activity and risk of metabolic phenotypes of obesity: a prospective Taiwanese cohort study in more than 200,000 adults. In: Mayo Clinic Proceedings. Elsevier; 2019. p. 2209–19.
  • Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Arch Intern Med. 2008;168(15):1617–24.
  • Ortega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. 2016;1752–70.
  • Goday A, Calvo E, Vázquez LA, Caveda E, Margallo T, Catalina-Romero C, et al. Prevalence and clinical characteristics of metabolically healthy obese individuals and other obese/non-obese metabolic phenotypes in a working population: results from the Icaria study. BMC Public Health. 2016;16:248.
Toplam 39 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORJİNAL MAKALE
Yazarlar

Burcu Güven Kacıroğlu

Hacer Hicran Mutlu 0000-0003-3712-0068

Yayımlanma Tarihi 30 Ocak 2021
Kabul Tarihi 29 Eylül 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 26 Sayı: 1

Kaynak Göster

Vancouver Güven Kacıroğlu B, Mutlu HH. Obezite Polikliniğine Başvuran Hastaların Metabolik Fenotiplerine Göre Kardiyovasküler Riskleri. Anadolu Klin. 2021;26(1):70-9.
 Kapak Resmi İndir

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.