Beyond obesity: metabolic status as a key driver for cardiovascular outcomes in patients undergoing invasive coronary angiography
Authors' conclusion
This study indicates metabolic health, rather than obesity, is a key predictor of adverse events in CCS prevention, revealing an obesity paradox in MH individuals. Thus, cardiovascular risk assessment should prioritize metabolic health over BMI. Integrating metabolic profiling into routine evaluations may help optimize prevention and personalized treatment strategies.
Study context
- Population
- Patients evaluated for chronic coronary syndrome (CCS) undergoing invasive coronary angiographypatients evaluated for CCS
- Participants
- 12,760 patients
- Comparison
- Metabolic phenotypes and outcomes
- Outcome
- MACE, all-cause mortality, and revascularization by metabolic phenotype
Methodological detailsadjusted for age, sex, and renal dysfunction
- Adjusted for age, sex, and renal dysfunction
Main finding
As reported in the abstract
- Irrespective of CCS, metabolic phenotypes showed different risks for MACE, all-cause mortality, and revascularization
- Metabolic disease emerged as a robust predictor of events, obesity alone did not
Further findings
| Outcome | Adj. HR (95% CI) | P value | |
|---|---|---|---|
| Events in patients with obstructive CCS, obese vs non-obeseMHOvs MHNObstructive CCS | 0.947 (0.728–1.231) | P = 0.683 | |
| Events in patients with obstructive CCS, obese vs non-obeseMUOvs MUNObstructive CCS | 0.974 (0.809–1.172) | P = 0.780 | |
| 0.512Adj. HR (log scale) |
Event rates by body mass index (BMI) in metabolically healthy (MH) individuals
- MH individuals experienced lower event rates with increasing body mass index (BMI)
Cohort characteristics
- Median age
- 68 years
- Male
- 57.3%
- MH
- 56.5%
- MH/metabolically unhealthy (MU)
- 43.5%
Original publication
Beyond obesity: metabolic status as a key driver for cardiovascular outcomes in patients undergoing invasive coronary angiography. Eur Heart J Qual Care Clin Outcomes. Published 29 April 2025. doi:10.
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