The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors

Abstract

BackgroundIn the last decade, several studies have reported an unexpected and seemingly paradoxical inverse correlation between BMI and incidence of cardiovascular diseases. This so called “obesity paradox effect” has been mainly investigated through imaging methods instead of histologic evaluation, which is still the best method to study the instability of carotid plaque. Therefore, the purpose of our study was to evaluate by histology the role of obesity in destabilization of carotid plaques and the interaction with age, gender and other major cerebrovascular risk factors.MethodsA total of 390 carotid plaques from symptomatic and asymptomatic patients submitted to endarterectomy, for whom complete clinical and laboratory assessment of major cardiovascular risk factors was available, were studied by histology. Patients with a BMI ≥ 30.0 kg/m2 were considered as obese. Data were analyzed by multivariate logistic regression and for each variable in the equation the estimated odds ratio (OR) was calculated.ResultsUnstable carotid plaque OR for obese patients with age < 70 years was 5.91 (95% CI 1.17–29.80), thus being the highest OR compared to that of other risk factors. Unstable carotid plaque OR decreased to 4.61 (95% CI 0.54–39.19) in males ≥ 70 years, being only 0.93 (95% CI 0.25–3.52) among women. When obesity featured among metabolic syndrome risk factors, the OR for plaque destabilization was 3.97 (95% CI 1.81–6.22), a significantly higher value compared to OR in non-obese individuals with metabolic syndrome (OR = 1.48; 95% CI 0.86–2.31). Similar results were obtained when assessing the occurrence of acute cerebrovascular symptoms.ConclusionsResults from our study appear to do not confirm any paradoxical effect of obesity on the carotid artery district. Conversely, obesity is confirmed to be an independent risk factor for carotid plaque destabilization, particularly in males aged < 70 years, significantly increasing such risk among patients with metabolic syndrome.

Long-Term Trajectories of BMI Predict Carotid Stiffness and Plaque Volume in Type 2 Diabetes Older Adults: a Cohort Study.

“…An additional study found an association of BMI in childhood, young adulthood and cumulative risk with impaired cIMT among healthy population 33 . In addition, obesity was found to be the most in uencing risk factor for unstable carotid plaque among men under 70 34 . A research looking at CVD risk trajectories from childhood to adulthood found that many of those who had consistently high BMIs during the life-course were better protected from carotid intima-media thickening if they were physically active 35 .…”

Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study

“…Obesity increases the risk of CV disease via dysregulated metabolism sharing the common mechanism with diabetes (e.g., insulin resistance and inflammation) [ 14 ]. In a study with 390 patients underwent surgical endarterectomy, obesity (BMI ≥ 30 kg/m 2 ) was associated with the vulnerable carotid plaque, particularly in males aged < 70 years [ 15 ]. The SPUM-ACS (Special Program University Medicine-Acute Coronary Syndrome) study showed that obese patients with ACS (BMI ≥ 30 kg/m 2 ) had a higher risk of MACE than normal-weight patients, which was driven by the increased risk of repeat revascularization [ 6 ].…”

Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study

“…Obesity increases the risk of CV disease via dysregulated metabolism sharing the common mechanism with diabetes (e.g., insulin resistance and in ammation) [14]. In a study with 390 patients underwent surgical endarterectomy, obesity (BMI ³ 30 kg/m 2 ) was associated with the vulnerable carotid plaque, particularly in males aged < 70 years [15]. The SPUM-ACS (Special Program University Medicine-Acute Coronary Syndrome) study showed that obese patients with ACS (BMI ³ 30 kg/m 2 ) had a higher risk of MACE than normal-weight patients, which was driven by the increased risk of repeat revascularization [6].…”