title: Coronary artery disease risk among obese metabolically healthy young men.
abstract: OBJECTIVE
  The aim of this study was to assess coronary artery disease (CAD) risk among obese young men without metabolic risk factors.
  
  
  METHODS
  A longitudinal study in a historical cohort.
  
  
  METHODS
  Incident CAD during a median follow-up of 6.1 years was assessed among 31,684 young men (mean age 31.2 ± 5.7 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults (MELANY) cohort. Participants were categorized by BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ≥ 30 kg/m(2) in the presence of normal blood pressure (BP) and normal levels of fasting glucose, triglyceride, and HDL-cholesterol (HDL-c) levels (n = 599; 1.9%). Cox proportional hazard models were applied.
  
  
  RESULTS
  There were 198 new cases of CAD that were diagnosed during 209,971 person-years of follow-up, of which six cases occurred among MH obese. The incidence of CAD among MH lean, overweight, and obese participants was 0.23, 0.45, and 1.0/1000 person-years respectively. In a multivariable model adjusted for clinical and biochemical CAD risk factors, a higher CAD risk was observed among MH-obese (hazard ratio = 3.08; 95% CI = 1.10-8.68, P = 0.033), compared to MH-normal weight subjects. This risk persisted when BMI was treated as a time-dependent variable, or when fasting glucose, HDL-c, triglycerides, or BP were added to the model. Similar results were also obtained when a more permissive definition of MH was used.
  
  
  CONCLUSIONS
  Obesity may continue to contribute to increased risk for incident CAD in young men even in the presence of a healthy metabolic profile.
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham 
authors.forename: Gilad
authors.initials: G
authors.lastname: Twig
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Ben-Ami Shor
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
authors.affiliation: Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine 'B'Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelIsrael Defense Forces Medical CorpsRamat Gan, IsraelDivision of Endocrinology and MetabolismPopulation Healthy Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, CanadaSackler School of MedicineTel Aviv University, Tel Aviv, IsraelIsrael Ministry of HealthJerusalem, IsraelDepartment of EndocrinologyChaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, IsraelDivision of EndocrinologyDiabetes and Hypertension, Harvard Medical School, Brigham 
authors.forename: Amir
authors.initials: A
authors.lastname: Tirosh
mesh_terms: D000328:Adult; D001786:Blood Glucose; D001794:Blood Pressure; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000453:epidemiology*; D050177:Overweight / Q000097:blood / Q000453:epidemiology; D016016:Proportional Hazards Models; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides