Association of Metabolic Obesity and BMI Status with Severity of Angiographic Coronary Artery Disease in Stable Angina Patients

Introduction: Obesity and metabolic syndrome frequently coexist and are one of the major health problems around the globe and its prevalence is 25-30%. In India prevalence of metabolic obesity is >= 30%, among females who have higher levels as compared to males. There is a significant proportion of the population who are obese (BMI >25 kg/m(2)) but metabolically healthy, likewise some people with normal BMI status, but metabolically obese. In this study, we have evaluated the association between metabolic obesity and severity of Coronary Artery Disease (CAD) in stable angina patients. Aim: To assess the association of severity of angiographic CAD based on the Metabolically Obese (MO) status and Body Mass Index (BMI). Materials and Methods: Total 408 subjects with stable angina and with positive stress test were included in the study and severity of CAD was measured by SYNTAX score. Obesity was defined as BMI >= 25 kg/m(2), and normal weight was defined as BMI <25 kg/m(2). The metabolic obesity was determined using the National Cholesterol Education Program-Adult Treatment Panel III (NCEPATP-III) classification in which Asian-specific cut-offs for abdominal obesity is used. Therefore, study subjects were categorised as follows: 1) Metabolically Healthy and Normal Weight (MHNW); 2) Metabolically Obese but Normal Weight (MONW); 3) Metabolically Healthy but Obese (MHO); and 4) Metabolically Abnormally Obese (MAO). Statistical analysis was carried out using statistical package for social sciences (SPSS) version 20. Baseline clinical, demographic, anthropometric and laboratory data are presented as mean +/- Standard Deviation (SD), median (range), or number (%) unless specified. Comparison among groups was calculated with an analysis of variance (ANOVA) test and Kruskal-Walis test for continuous variables and the Pearson chi-square test for categorical variables. Association between groups and severity of CAD was done by Kruskal-Wallis test. The p-value <0.05 was considered statistically significant. Results: Out of 408, 70.3% (n=287) subjects were male, 52.7% (n=215) subjects were hypertensive, and 42.9% (n=175) subjects had high BMI. Metabolic obesity showed higher prevalence of CAD (MO, OR=0.25, 95% (1): 0.31-1.03) than patients with higher BMI status (BMI, OR=1.39, 95% (1): 0.79-2.4). Syntax score which measures the severity of CAD is marginally high in MONW group (p-value-0.003) when compared to MHNW group. Conclusion: MO group was associated with a high prevalence and severity for CAD than metabolically healthy group irrespective of their weight status.