Metabolically Abnormal Obesity and Carotid Plaque Vulnerability: A Vessel Wall MRI Study Linking Obesity Phenotypes to Atherosclerotic Instability.

IF 7.4 1区医学 Q1 HEMATOLOGY

Arteriosclerosis, Thrombosis, and Vascular Biology Pub Date : 2025-09-18 DOI:10.1161/ATVBAHA.125.323413

Sai Shao, Yan Sun, Honglu Shi, Rui Li, Qinjian Sun, Bin Yao, Hiroko Watase, Daniel S Hippe, Chun Yuan, Guangbin Wang, Quan Zhang, Xihai Zhao

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引用次数: 0

Abstract

Background: Carotid plaque vulnerability, driven by metabolic dysfunction and obesity, is a critical determinant of ischemic stroke risk. However, the heterogeneity of obesity phenotypes-defined by metabolic health-remains underexplored in cardiovascular risk stratification. Therefore, this study employs high-resolution magnetic resonance vessel wall imaging to assess differences in high-risk carotid plaque features among obesity subtypes stratified by metabolic dysfunction and body mass index.

Methods: This multicenter, cross-sectional study of 1037 Chinese adults with symptomatic carotid atherosclerosis utilized magnetic resonance vessel wall imaging to assess differences in high-risk carotid plaque features-intraplaque hemorrhage (IPH), lipid-rich necrotic core, and fibrous cap rupture-across 4 obesity phenotype subgroups: metabolically healthy normal weight (MHNW), metabolically abnormal normal weight, metabolically healthy obese (MHO), and metabolically abnormal obese (MAO).

Results: Of 1037 eligible patients, the proportion of patients in MHNW, metabolically abnormal normal weight, MHO, and MAO groups was 51.6% (n=535), 6.9% (n=72), 16.7% (n=173), and 24.8% (n=257), respectively. Both prevalences of high-risk carotid plaque (22.5% versus 16.6% in MHNW; P=0.002) and IPH (17.1% versus 10.1% in MHNW; P<0.001) in the MAO group were higher than those in the MHNW and MHO groups (all P<0.05). The MHO group exhibited plaque stability similar to MHNW, whereas metabolically abnormal normal weight had greater maximum wall thickness (P=0.004) than MHO and higher IPH prevalence than MHNW (P=0.054). Several carotid plaque morphological variables significantly differed among the 4 groups (all P<0.05). In further adjusted logistic regression models, MAO was independently associated with IPH (P=0.015), alongside male sex, advanced age, and antihypertensive agent use.

Conclusions: This study redefines the role of obesity in atherosclerosis by prioritizing metabolic health over body mass index, demonstrating that MAO is independently associated with IPH and exhibits elevated high-risk carotid plaque/IPH prevalence versus MHNW/MHO. The robustness of IPH as a metabolic instability indicator warrants particular attention.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02017756.

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代谢异常肥胖和颈动脉斑块易感性：一项将肥胖表型与动脉粥样硬化不稳定性联系起来的血管壁MRI研究。

背景：代谢功能障碍和肥胖导致的颈动脉斑块易损性是缺血性卒中风险的关键决定因素。然而，由代谢健康定义的肥胖表型的异质性在心血管风险分层中仍未得到充分探讨。因此，本研究采用高分辨率磁共振血管壁成像来评估按代谢功能障碍和体重指数分层的肥胖亚型之间高危颈动脉斑块特征的差异。方法：这项多中心、横断面研究对1037名有症状的中国成年颈动脉粥样硬化患者进行了磁共振血管壁成像，以评估高危颈动脉斑块特征的差异——斑块内出血（IPH）、富含脂质的坏死核心和纤维帽破裂——跨越4个肥胖表型亚组：代谢健康正常体重（MHNW）、代谢异常正常体重、代谢健康肥胖（MHO）和代谢异常肥胖（MAO）。结果：1037例符合条件的患者中，MHNW组、代谢异常正常体重组、MHO组和MAO组患者比例分别为51.6% （n=535）、6.9% （n=72）、16.7% （n=173）和24.8% （n=257）。高危颈动脉斑块（MHNW为22.5%比16.6%，P=0.002）和IPH （MHNW为17.1%比10.1%，PPP=0.004）的患病率均高于MHO， IPH患病率高于MHNW （P=0.054）。4组患者颈动脉斑块形态学的几个变量与男性、高龄和抗高血压药物的使用有显著差异（均PP=0.015）。结论：本研究通过优先考虑代谢健康而不是体重指数，重新定义了肥胖在动脉粥样硬化中的作用，证明MAO与IPH独立相关，并且与MHNW/MHO相比，颈动脉斑块/IPH患病率升高。IPH作为代谢不稳定指标的稳健性值得特别注意。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02017756。

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来源期刊

Arteriosclerosis, Thrombosis, and Vascular Biology 医学-外周血管病

CiteScore

15.60

自引率

2.30%

发文量

337

审稿时长

2-4 weeks

期刊介绍： The journal "Arteriosclerosis, Thrombosis, and Vascular Biology" (ATVB) is a scientific publication that focuses on the fields of vascular biology, atherosclerosis, and thrombosis. It is a peer-reviewed journal that publishes original research articles, reviews, and other scholarly content related to these areas. The journal is published by the American Heart Association (AHA) and the American Stroke Association (ASA). The journal was published bi-monthly until January 1992, after which it transitioned to a monthly publication schedule. The journal is aimed at a professional audience, including academic cardiologists, vascular biologists, physiologists, pharmacologists and hematologists.