Metabolic illusion: Earlier coronary disease in ‘healthy’ obese patients.

Abstract

Aim: This study evaluates differences in demographics and all-cause mortality at 30 days post-percutaneous coronary intervention (PCI) between the so called metabolically healthy obese (MHO) patients (BMI >30) and non-obese patients (BMI ≤30) without standard modifiable cardiovascular risk factors (SMuRFs). The secondary endpoint is major adverse cardiovascular and cerebrovascular events (MACCE), comprising all-cause mortality, myocardial infarction, target vessel revascularization, or stroke at 30-day follow-up. Method: All PCI cases from the Melbourne Interventional Group (MIG) registry (2004–2020) were analysed. Patients with SMuRFs, incomplete data, or prior coronary events were excluded. Cox-proportional model adjusted for age was utilised to assess differences in outcomes in the MHO and non-MHO groups. Results: Among 2,923 PCI patients without SMURFs, 676 (23.1%) were classified as MHO. The mean BMI was 33.9 kg/m 2 in the MHO group and 25.4 kg/m 2 in the non-MHO group. MHO patients were younger, with a mean age of 59.5 years compared to 64.4 years in non-MHO patients (p<0.001). After adjusting for age, there was no significant difference in all-cause mortality at 30 days (HR 0.61; 95% CI 0.30–1.25, p=0.18). However, MHO patients had a significantly lower risk of MACCE at 30 days (HR 0.56; 95% CI 0.35–0.88, p=0.01). Conclusions: Obesity alone does not appear to be independently associated with higher short-term mortality following PCI in patients without traditional cardiovascular risk factors. The significant younger age at time of first PCI in the MHO group may suggests an earlier development of coronary disease in this group compared to the non-MHO group.