CARDIOVASCULAR RISK ASSESSED VIA RETINAL IMAGING IN METABOLICALLY HEALTHY OBESITY (MHO) AND METABOLICALLY HEALTHY OVERWEIGHT (MHOW)

Therapeutic Area

ASCVD/CVD Risk Assessment

Background

Metabolically healthy obesity (MHO) and metabolically healthy overweight (MHOW) represent subsets of individuals with elevated BMI but favourable metabolic profiles. Despite their classification as "metabolically healthy," the cardiovascular risk in these groups remains unclear. This study examines the association between MHO, MHOW, and retinal-based cardiovascular risk scores (Dr. Noon CVD) to understand their implications for cardiovascular disease prevention better.

Methods

Data for this study were derived from the UK Biobank (N=59,493). Among the participants, metabolically healthy individuals (N=15,947) were categorised into groups based on BMI: metabolically healthy normal weight (MHN, N=8,410), metabolically healthy overweight (MHOW, N=5,753) and metabolically healthy obese (MHO, N=1,784). BMI was categorised as normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥30 kg/m²). Metabolic health was defined as systolic blood pressure <130 mmHg without antihypertensive drugs, waist-to-hip ratio <0.95 for women or <1.03 for men, and absence of diabetes. Dr. Noon CVD scores were derived from retinal fundus images and validated in several populations. Linear regression models were used to examine associations between metabolic phenotypes and Dr. Noon CVD scores, adjusting for demographic, socioeconomic, and lifestyle factors.

Results

MHO and MHOW individuals showed 10.50% (p<0.001) and 16.39% (p<0.001) higher Dr. Noon CVD scores compared to metabolically healthy normal-weight (MHN) individuals, respectively. Lifestyle factors significantly influenced Dr. Noon CVD scores within both the MHO and MHOW groups, with higher physical activity levels and healthier dietary patterns correlating with reduced cardiovascular risk.

Conclusions

In MHO and MHOW individuals, the CVD risk remains elevated relative to metabolically healthy normal-weight individuals (MHN). This result indicates that Dr. Noon CVD biomarker may be a useful tool for early risk detection in these individuals and help implement targeted interventions to prevent future disease burden.