Background: Whether obesity in the absence of cardiometabolic abnormalities increases the risk of subclinical atherosclerosis remains debatable.

Methods: We compared coronary artery calcium (CAC) across obesity phenotypes in 505 Whites and 306 African Americans (AAs) from the Genetic Study of Aspirin Responsiveness (GeneSTAR); and 875 South Asians (SAs) from MASALA (Mediators of Atherosclerosis in South Asians Living in America). Using BMI and the International Harmonized Definition of metabolic syndrome, participants were categorized as Metabolically Healthy Non-Obese (MHNO), Metabolically Healthy Obese (MHO), Metabolically Unhealthy Non-Obese (MUNO), and Metabolically Unhealthy Obese (MUO).

Results: The prevalence of any detectable CAC was similar in MHNO versus MHO among all ethnic groups (Whites 35 versus 30%, AAs 30 versus 23%, SAs 29 versus 26%; respectively, all p>0.05). In contrast, the prevalence of CAC was the highest in the MUNO and MUO groups in all ethnic groups. After adjusting for potential confounders; the odds of CAC in MUNO and MUO compared to MHNO were significantly higher in Whites and SAs; but not in AAs.

Conclusion: Metabolically unhealthy Whites, AAs, and SAs had higher CAC scores regardless of obesity status suggesting that metabolic health is more closely associated with atherosclerosis than obesity alone especially in Whites and SAs.


M. Al-Sofiani: Speaker’s Bureau; Self; Novo Nordisk Inc. D. Vaidya: None. A.M. Kanaya: None. L. Yanek: None. M. Mongraw-Chaffin: None. N.R. Kandula: None. L. Becker: None. B.G. Kral: None. D. Becker: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions. C. Lee: Employee; Self; Eli Lilly and Company.


National Institutes of Health (R01HL093009, K24HL112827); National Center for Research Resources (UL1RR024131, M01-RR000052); National Heart, Lung, and Blood Institute (U01HL72518)

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