Jose Ordovás, PhD, on Body Size and Its Effect on Subclinical Atherosclerosis Prevalence – MedPage Today

Body size affects the prevalence of subclinical atherosclerosis (SA), suggesting medication and other lifestyle changes could improve cardiac risk in those who fall into a riskier body-size category, new study findings show.

The data, published in The Journal of Clinical Endocrinology & Metabolism, showed that in metabolically healthy persons, SA prevalence increased alongside body mass index (BMI) categories (49.6% for normal weight, 58.0% for overweight, 67.7% for obese).

Jose Maria Ordovás, PhD, lead scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, served as co-author of the study. He recently discussed the study findings with MedPage Today. The exchange has been edited for length and clarity.

This study examined subclinical atherosclerosis in middle-aged individuals. What specific question was this study designed to address?

Ordovás: There is increasing scientific evidence about inter-individual differences in the link between overweight/obesity and a range of diseases. To better understand this variability in relation to the early stages of atherosclerosis, this study aimed to evaluate the association between body-size phenotypes and subclinical atherosclerosis in a population of middle-aged asymptomatic individuals (n=3,909).

Six body-size phenotypes were defined according to whether they had at least one cardiometabolic abnormality (blood pressure, fasting blood glucose, triglycerides, low high-density lipoprotein cholesterol, homeostasis model assessment-insulin resistance index, high-sensitivity C-reactive protein) and based on BMI: normal weight (BMI<25), overweight (BMI=25-29.9), or obese (BMI>30). The outcome of subclinical atherosclerosis was evaluated by 2-D vascular ultrasonography and non-contrast cardiac computed tomography.

What were the key findings?

Ordovás: First, the most common phenotype for middle-aged men was overweight-metabolically unhealthy, whereas women were predominantly normal weight-metabolically healthy.

Second, for metabolically healthy subjects, the presence of subclinical atherosclerosis increased across BMI categories, whereas for metabolically unhealthy subjects, fewer differences were observed between overweight and obese subjects in terms of subclinical atherosclerosis in comparison to their normal-weight counterparts.

Third, we found that the association of BMI with subclinical atherosclerosis seems to be mostly driven by the coexistence of cardiometabolic risk factors.

What do you see as the potential implications of these findings from a research perspective, a clinical perspective, or both?

Ordovás: Obesity is an expanding worldwide public health epidemic with enormous medical and socioeconomic consequences. We have observed an increasing prevalence of SA across BMI categories for metabolically healthy people and a steady prevalence in overweight and obese metabolically unhealthy persons compared to their normal-weight counterparts.

Pharmacologic and lifestyle interventions might modify their cardiovascular risk by facilitating the transition from one phenotype to another. To date, obesity treatment recommendations do not consider differences between healthy and unhealthy overweight or obese phenotypes.

However, the stratification of obese individuals based on their cardiometabolic phenotype may be important to identify those who are to be prioritized for early pharmacological treatment in addition to lifestyle intervention. Therefore, the results of this research are important for two interconnected areas such as precision medicine and precision nutrition.

You can read the study here and also expert commentary on the clinical implications here.

Ordovás reported receiving grants and other financial support from USDA, Archer Daniels Midland, Scientific Advisory Board/consultant for Nutrigenomix, the Predict Study, GNC, and Weight Watchers.

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