Metabolically Abnormal Obesity and Carotid Plaque Vulnerability: A Vessel Wall MRI Study Linking Obesity Phenotypes to Atherosclerotic Instability

作者：Sai Shao, Yan Sun, Honglu Shi, R. Li, Qinjian Sun, Bin Yao, Hiroko Watase, Daniel S. Hippe, Chun Yuan, Guangbin Wang, Quan Zhang, Xihai Zhao, Investigators of CARE-II Study · 发表于：Arteriosclerosis Thrombosis and Vascular Biology · 年份：2025 · DOI：10.1161/atvbaha.125.323413 · 被引用次数：4 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Cardiovascular Health and Disease Prevention、Aortic Thrombus and Embolism

BACKGROUND: Carotid plaque vulnerability, driven by metabolic dysfunction and obesity, is a critical determinant of ischemic stroke risk. However, the heterogeneity of obesity phenotypes—defined by metabolic health—remains underexplored in cardiovascular risk stratification. Therefore, this study employs high-resolution magnetic resonance vessel wall imaging to assess differences in high-risk carotid plaque features among obesity subtypes stratified by metabolic dysfunction and body mass index. METHODS: This multicenter, cross-sectional study of 1037 Chinese adults with symptomatic carotid atherosclerosis utilized magnetic resonance vessel wall imaging to assess differences in high-risk carotid plaque features—intraplaque hemorrhage (IPH), lipid-rich necrotic core, and fibrous cap rupture—across 4 obesity phenotype subgroups: metabolically healthy normal weight (MHNW), metabolically abnormal normal weight, metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). RESULTS: Of 1037 eligible patients, the proportion of patients in MHNW, metabolically abnormal normal weight, MHO, and MAO groups was 51.6% (n=535), 6.9% (n=72), 16.7% (n=173), and 24.8% (n=257), respectively. Both prevalences of high-risk carotid plaque (22.5% versus 16.6% in MHNW; P =0.002) and IPH (17.1% versus 10.1% in MHNW; P <0.001) in the MAO group were higher than those in the MHNW and MHO groups (all P <0.05). The MHO group exhibited plaque stability similar to MHNW, whereas metabolica...