Cardiovascular risks according to metabolic phenotypes of patients admitted to an obesity outpatient clinic

Öz

Aim: Obesity is a condition that increases cardiovascular risk due to both the pro-inflammatory effect of increased adipose tissue and frequently associated diseases. The effect of metabolic healthy obesity on cardiovascular risk is controversial. In our study, we aimed to determine the cardiovascular risk profile according to the metabolic phenotype of the patients who applied to our obesity outpatient clinic using the plasma atherogenic index (PAI).

Materials and Methods: PAI was used to assess the cardiovascular risks of the participants. Those who do not have any metabolic syndrome criteria other than increased waist circumference (blood pressure≥130/85 mmHg, fasting blood sugar≥100 mg/dl, triglyceride≥150 mg/dl, HDL-K<40 mg/dl in men, <50 mg/dl in women or who used drugs lowering these parameters) were defined as metabolically healthy obese and those with any of these criteria were defined as metabolic unhealthy obese.

Results: Most of the participants (76.9%) were found to be in the group with high cardiovascular risk. The sociodemographic and anthropometric factors affecting cardiovascular risk appeared to be the body mass index (BMI), body fat and muscle amount, smoking habit, exercise habits and metabolic phenotype. It was found that 14.1% (n=137) of the patients were metabolically healthy and 85.9% (n=838) of them were metabolically unhealthy. Women had more metabolically healthy phenotypes than men (p=0.009). Metabolic unhealthy obese patients were older (p=0.006). Metabolically healthy obese people had lower BMI, body fat and muscle mass (p<0.001; p<0.001; p<0.001). PAI values of metabolically unhealthy obese individuals were significantly higher than those of metabolically healthy obese individuals (p<0.001).

Conclusion: It was concluded that most of the obese individuals were in the high cardiovascular risk group and the cardiovascular risk of metabolically unhealthy obese people was significantly higher than that of metabolic healthy obese people. The high amount of BMI and body fat of metabolically unhealthy individuals suggested that as the amount of BMI and fat increases, a transition may occur from metabolic healthiness to unhealthiness and the cardiovascular risk may increase over time.

Anahtar Kelimeler

• Obesity
• metabolic syndrome
• cardiovascular system
• atherosclerosis

Obezite Polikliniğine Başvuran Hastaların Metabolik Fenotiplerine Göre Kardiyovasküler Riskleri

Öz

Amaç: Obezite, hem artan yağ dokusunun pro-inflamatuar etkisi, hem de sıklıkla birliktelik gösteren hastalıklar nedeniyle kardiyovasküler riski arttıran bir durumdur. Son zamanlarda metabolik sağlıklı obezitenin kardiyovasküler risk üzerine olan etkisi tartışmalıdır. Çalışmamızda, plazma aterojenik indeksi (PAİ) kullanılarak obezite polikliniğimize başvuran hastaların metabolik fenotipine göre kardiyovasküler risk profilini saptamak amaçlanmıştır.

Gereç ve Yöntemler: Katılımcıların kardiyovasküler riskini değerlendirmek için PAİ kullanıldı. Metabolik sendrom kriterlerinden bel çevresi artışı dışında herhangi bir metabolik sendrom kriterine sahip olmayanlar (kan basıncı≥130/85 mmHg, açlık kan şekeri≥100 mg/dl, trigliserit≥150 mg/dl, HDL-K erkeklerde<40 mg/dl, kadınlarda <50 mg/dl veya bu parametreleri düşürücü ilaç kullananlar) metabolik sağlıklı obez, bu kriterlerden herhangi birine sahip olanlar ise metabolik sağlıksız obez olarak tanımlandı.

Bulgular: Tüm katılımcıların PAİ ile kardiyovasküler riski değerlendirildiğinde %76,9’unun (n=722) yüksek kardiyovasküler riskli grupta olduğu ve kardiyovasküler riski etkileyen sosyodemografik ve antropometrik faktörlerin cinsiyet, vücut kütle indeksi (VKİ), vücut yağ ve kas miktarı, sigara içme alışkanlığı, egzersiz alışkanlığı ve metabolik fenotip olduğu görülmektedir. Katılımcıların metabolik fenotipleri incelendiğinde %14,1’inin (n=137) metabolik sağlıklı, %85,9’unın (n=838) metabolik sağlıksız olduğu saptanmıştır. Kadınlar, erkeklere göre daha çok metabolik sağlıklı fenotipine sahiptir (p=0,009). Metabolik sağlıksız obezlerin yaşı daha ileridir (p=0,006). Metabolik sağlıklı obezlerin VKİ, vücut yağ ve kas kütleleri daha düşüktür (sırasıyla p<0,001; p<0,001; p<0,001). Metabolik sağlıksız obez bireylerin PAİ değerleri metabolik sağlıklı obez bireylerden anlamlı olarak daha yüksektir (p<0,001).

Sonuç: Genel olarak değerlendirildiğinde obez bireylerin çoğunun yüksek kardiyovaküler riskli grupta olduğu, metabolik sağlıksız obez kişilerin kardiyovasküler riskinin metabolik sağlıklı obezlere göre anlamlı olarak daha yüksek olduğu sonucu çıkmıştır. Metabolik sağlıksız bireylerin VKI ve vücut yağ miktarlarının fazla olması, VKI ve yağ miktarı arttıkça metabolik sağlıklı bireylerin metabolik sağlıksızlığa doğru geçiş yapabileceği ve kardiyovasküler riskinin zamanla artabileceğini düşündürmüştür.

Anahtar Kelimeler

• Obezite
• metabolik sendrom
• kardiyovasküler sistem
• ateroskleroz

Kaynakça

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