Burden of subclinical cardiovascular disease in "metabolically benign" and "at-risk" overweight and obese women

The Study of Women's Health Across the Nation (SWAN)

Unab I. Khan, Dan Wang, Rebecca C. Thurston, MaryFran Sowers, Kim Sutton-Tyrrell, Karen A. Matthews, Emma Barinas-Mitchell, Rachel P. Wildman

Research output: Contribution to journalArticle

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Abstract

Background: Metabolically benign obese individuals have a 10-year cardiovascular disease (CVD) risk comparable to healthy normal weight individuals. However, the burden of subclinical CVD among metabolically benign obese is not well known. Methods: In cross-sectional analyses of 475 mid-life women, we compared common carotid artery intima media thickness (CCA-IMT), aortic pulse wave velocity (aPWV) and coronary (CAC) and aortic calcification (AC) among three groups: healthy normal weight, metabolically benign overweight/obese (<3 metabolic syndrome components/elevated CRP), and at-risk overweight/obese (≥3 metabolic syndrome components/elevated CRP). Results: The mean (SD) CCA-IMT and aPWV were lowest in the normal weight group (n= 145), followed by the benign overweight/obese (n= 260) and at-risk overweight/obese (n= 70) groups [CCA-IMT: 0.64 (0.08) vs. 0.68 (0.09) vs. 0.73 (0.13) mm, p<. 0.001; aPWV: 731.0 (176.4) vs. 809.9 (182.3) vs. 875.7 (228.8) cm/s, p<. 0.001]. Similar results were found for the frequency (%) of women with increased CAC and AC [CAC: 13 (9%) vs. 53(20%) vs. 28(40%), p<. 0.001; AC: 47(32%) vs. 130 (50%) vs. 55(79%), p<. 0.001]. These differences remained significant after multivariable adjustment. Further adjustment for BMI attenuated the statistical significance of differences in aPWV and calcification between benign and at-risk overweight/obese women, but had little effect on the magnitude of these differences. Conclusions: Metabolically benign overweight/obese women have a significantly greater subclinical CVD burden than normal weight women, despite published data finding similar CVD event rates between the two groups. Prospective studies tracking the progression of subclinical atherosclerosis to clinical CVD in these women are needed.

Original languageEnglish (US)
Pages (from-to)179-186
Number of pages8
JournalAtherosclerosis
Volume217
Issue number1
DOIs
StatePublished - Jul 2011

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Women's Health
Pulse Wave Analysis
Cardiovascular Diseases
Carotid Intima-Media Thickness
Common Carotid Artery
Weights and Measures
Atherosclerosis
Cross-Sectional Studies
Prospective Studies

Keywords

  • Aortic calcification
  • Carotid intima media thickness
  • Coronary calcification
  • Obesity phenotypes
  • Pulse wave velocity
  • Subclinical atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Burden of subclinical cardiovascular disease in "metabolically benign" and "at-risk" overweight and obese women : The Study of Women's Health Across the Nation (SWAN). / Khan, Unab I.; Wang, Dan; Thurston, Rebecca C.; Sowers, MaryFran; Sutton-Tyrrell, Kim; Matthews, Karen A.; Barinas-Mitchell, Emma; Wildman, Rachel P.

In: Atherosclerosis, Vol. 217, No. 1, 07.2011, p. 179-186.

Research output: Contribution to journalArticle

Khan, Unab I. ; Wang, Dan ; Thurston, Rebecca C. ; Sowers, MaryFran ; Sutton-Tyrrell, Kim ; Matthews, Karen A. ; Barinas-Mitchell, Emma ; Wildman, Rachel P. / Burden of subclinical cardiovascular disease in "metabolically benign" and "at-risk" overweight and obese women : The Study of Women's Health Across the Nation (SWAN). In: Atherosclerosis. 2011 ; Vol. 217, No. 1. pp. 179-186.
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T2 - The Study of Women's Health Across the Nation (SWAN)

AU - Khan, Unab I.

AU - Wang, Dan

AU - Thurston, Rebecca C.

AU - Sowers, MaryFran

AU - Sutton-Tyrrell, Kim

AU - Matthews, Karen A.

AU - Barinas-Mitchell, Emma

AU - Wildman, Rachel P.

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N2 - Background: Metabolically benign obese individuals have a 10-year cardiovascular disease (CVD) risk comparable to healthy normal weight individuals. However, the burden of subclinical CVD among metabolically benign obese is not well known. Methods: In cross-sectional analyses of 475 mid-life women, we compared common carotid artery intima media thickness (CCA-IMT), aortic pulse wave velocity (aPWV) and coronary (CAC) and aortic calcification (AC) among three groups: healthy normal weight, metabolically benign overweight/obese (<3 metabolic syndrome components/elevated CRP), and at-risk overweight/obese (≥3 metabolic syndrome components/elevated CRP). Results: The mean (SD) CCA-IMT and aPWV were lowest in the normal weight group (n= 145), followed by the benign overweight/obese (n= 260) and at-risk overweight/obese (n= 70) groups [CCA-IMT: 0.64 (0.08) vs. 0.68 (0.09) vs. 0.73 (0.13) mm, p<. 0.001; aPWV: 731.0 (176.4) vs. 809.9 (182.3) vs. 875.7 (228.8) cm/s, p<. 0.001]. Similar results were found for the frequency (%) of women with increased CAC and AC [CAC: 13 (9%) vs. 53(20%) vs. 28(40%), p<. 0.001; AC: 47(32%) vs. 130 (50%) vs. 55(79%), p<. 0.001]. These differences remained significant after multivariable adjustment. Further adjustment for BMI attenuated the statistical significance of differences in aPWV and calcification between benign and at-risk overweight/obese women, but had little effect on the magnitude of these differences. Conclusions: Metabolically benign overweight/obese women have a significantly greater subclinical CVD burden than normal weight women, despite published data finding similar CVD event rates between the two groups. Prospective studies tracking the progression of subclinical atherosclerosis to clinical CVD in these women are needed.

AB - Background: Metabolically benign obese individuals have a 10-year cardiovascular disease (CVD) risk comparable to healthy normal weight individuals. However, the burden of subclinical CVD among metabolically benign obese is not well known. Methods: In cross-sectional analyses of 475 mid-life women, we compared common carotid artery intima media thickness (CCA-IMT), aortic pulse wave velocity (aPWV) and coronary (CAC) and aortic calcification (AC) among three groups: healthy normal weight, metabolically benign overweight/obese (<3 metabolic syndrome components/elevated CRP), and at-risk overweight/obese (≥3 metabolic syndrome components/elevated CRP). Results: The mean (SD) CCA-IMT and aPWV were lowest in the normal weight group (n= 145), followed by the benign overweight/obese (n= 260) and at-risk overweight/obese (n= 70) groups [CCA-IMT: 0.64 (0.08) vs. 0.68 (0.09) vs. 0.73 (0.13) mm, p<. 0.001; aPWV: 731.0 (176.4) vs. 809.9 (182.3) vs. 875.7 (228.8) cm/s, p<. 0.001]. Similar results were found for the frequency (%) of women with increased CAC and AC [CAC: 13 (9%) vs. 53(20%) vs. 28(40%), p<. 0.001; AC: 47(32%) vs. 130 (50%) vs. 55(79%), p<. 0.001]. These differences remained significant after multivariable adjustment. Further adjustment for BMI attenuated the statistical significance of differences in aPWV and calcification between benign and at-risk overweight/obese women, but had little effect on the magnitude of these differences. Conclusions: Metabolically benign overweight/obese women have a significantly greater subclinical CVD burden than normal weight women, despite published data finding similar CVD event rates between the two groups. Prospective studies tracking the progression of subclinical atherosclerosis to clinical CVD in these women are needed.

KW - Aortic calcification

KW - Carotid intima media thickness

KW - Coronary calcification

KW - Obesity phenotypes

KW - Pulse wave velocity

KW - Subclinical atherosclerosis

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