Association of obesity phenotypes with electrocardiographic subclinical myocardial injury in the general population

Abstract

Background As the debate continues about whether obesity in metabolically healthy individuals is associated with poor outcomes or not, investigating the association between the obesity phenotypes and markers of subclinical myocardial injury will help identify those at risk for future cardiovascular events (cardiovascular disease [CVD]). Hypothesis We hypothesize that obesity phenotypes including metabolically healthy obesity (MHO) is associated with subclinical myocardial injury (SC‐MI). Methods This analysis included 3423 participants (57.85 ± 13.06 years, 53.3% women) without known CVD from National Health and Nutrition Examination Survey (NHANES) III. Multivariable logistic regression models were used to examine the cross‐sectional association between four obesity phenotypes (metabolically healthy nonobese (MHNO) [reference], metabolically unhealthy nonobese (MUNO), MHO, and metabolically unhealthy obese (MUO) with SC‐MI. SC‐MI was defined from the 12‐lead electrocardiogram as cardiac infarction/injury score ≥ 10 units. Metabolic syndrome (MetS) was defined according to the International Diabetes Federation consensus definition. Obesity was defined as body mass index ≥30 kg/m 2 . Results MUO was associated with higher odds of SC‐MI compared with MHNO (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.22‐1.92, P = 0.0005). This association was stronger in men vs women (OR [95% CI]: 2.20 [1.58‐2.07] vs 1.08 [0.79‐1.48]), respectively; interaction P ‐value = 0.002) but was consistent in subgroups stratified by age and race. There was no significant association of MHO or MUNO with SC‐MI compared with MHNO, but there was a trend toward higher odds of SC‐MI in the MUNO group ( P ‐value for trend across MHNO, MUNO, and MUO = 0.0002). Conclusions Our findings suggest that a combination of obesity and MetS confers worse prognosis and early preventive strategies aimed at weight loss and management of MetS components may decrease the risk of future poor outcomes.

Higher Serum Neuropeptide Y Levels Are Associated with Metabolically Unhealthy Obesity in Obese Chinese Adults: A Cross-Sectional Study

“…There were significant differences between the two phenotypes in anthropometric and biochemical parameters, as shown in our study. Among these obese participants, MUO were more likely to be old compared to MHO, coincident with the research by Vasim et al [34]. What's more, the risk of cardiovascular events among the MUO population is significantly higher than in the MHO population [1].…”

Elevated circulating high-sensitivity cardiac troponin t and cardiac remodeling in obesity

“…However, to our best knowledge, few studies directly explore the relationship between obesity and subclinical myocardial injury, taking coronary artery diseases into account. A study based on National Health and Nutrition Examination Survey (NHASNES) III suggested that obesity is positively associated with subclinical myocardial injury [ 7 ]. But what is more noteworthy is that there are virtually no studies excluding the effects of coronary vascular lesions on myocardial injury through the gold standard coronary angiography to prove the correlation between obesity and myocardial injury.…”

Association Between C-Peptide Level and Subclinical Myocardial Injury

“…Analysis of electrocardiograms was achieved through a computerized automated process and visual inspection by a trained technician located in a centralized core laboratory. Briefly, the SC-MI defined from the CIIS rests on a weighted scoring system taking several objective electrocardiographic waveform components related to myocardial injury and ischemia, both discrete and continuous, and generating a riskstratified scoring system (6,7). A combination of 11 discrete and 4 continuous variables are counted to define the final score to evaluate the disease severity levels: CIIS>20 for probable injury; CIIS>15 for possible injury; CIIS>10 for borderline abnormality.…”

“…Previous studies have reported that physical activity (5), obesity (6), diastolic blood pressure (7), Vitamin D (8) and TyG index (9) were associated with SC-MI.…”