Relationship between metabolically healthy obesity and coronary artery calcification

There is a lack of consensus regarding universally accepted criteria for metabolic health (MH). A simple definition of MH was systematically derived in a recent prospective cohort study. The present cross-sectional study aimed to explore the applicability of these criteria in Korean population, using coronary calcification as an indicator of cardiovascular risk. In total, 1049 healthy participants, who underwent coronary artery calcification testing at university hospital health promotion centers between January and December 2022, were included. Applying the main components of the newly derived definition, MH was defined as follows: (1) systolic blood pressure < 130 mmHg and no use of blood pressure-lowering medication; (2) waist circumference < 90 cm for males and < 85 cm for females; and (3) absence of diabetes. Multivariate logistic regression was conducted to examine the odds ratio (OR) and 95 % confidence interval (CI) for coronary artery calcium score across different phenotypes. The prevalence of coronary artery calcification in this study was 41.1 %. Compared with metabolically healthy, normal weight subjects, those with the metabolically healthy obesity phenotype did not exhibit increased odds for coronary atherosclerosis. (OR 0.93 [95 % CI 0.48–1.79]) Conversely, metabolically unhealthy subjects had increased risk, regardless of their body mass index category (OR 3.10 [95 % CI 1.84–5.24] in metabolically unhealthy normal weight; OR 3.21 [95 % CI 1.92–5.37] in metabolically unhealthy overweight; OR 2.73 [95 % CI 1.72–4.33] in metabolically unhealthy obese phenotype). These findings suggest that the new definition for MH has the potential to effectively distinguish individuals at risk for cardiovascular disease from those who are not.