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Cardiac Imaging and Diagnostics / Diabetes, Cardiovascular Risks, and Lipoproteins · Journal article
European Journal of Medical Research · August 18, 2026
Encouraging direction, but not yet definitive.
This cross-sectional hospital study of 9,051 patients demonstrates that metabolically unhealthy status (with or without obesity) is associated with angiographically confirmed obstructive CAD, with the strongest effect sizes observed in young adults ≤45 years. Two exploratory metabolic phenotypes showed markedly elevated odds of CAD in young adults, but the cross-sectional design precludes causal inference and the findings require prospective validation.
Hospital-based cross-sectional study. Hospital patients with and without angiographically confirmed obstructive coronary artery disease (stenosis ≥50%). Total 9,051 analysed; 62.1% male, 15.2% obese, mean age 50.06 ± 15.14 years.. Intervention: Metabolically unhealthy non-obesity (MUN) and metabolically unhealthy obesity (MUO) status, defined by metabolic and obesity criteria.. Compared with: Metabolically healthy non-obesity (reference group). n = 9,051.
Among 9,051 participants, obstructive CAD was detected in 3,523 (38.9%) Young adults with metabolically unhealthy non-obesity (MUN) showed adjusted OR 5.02 (95% CI 3.24–7.84) for CAD Young adults with metabolically unhealthy obesity (MUO) showed adjusted OR 5.06 (95% CI 3.11–8.29) for CAD
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These findings suggest that metabolic dysfunction without obesity may confer substantial CAD risk in young adults, warranting investigation of metabolic screening and intervention in this age group. The exploratory phenotypes merit prospective validation before clinical implementation.
Hospital-based cross-sectional study with large sample and multivariate analysis showing age-specific associations between metabolic phenotypes and angiographically confirmed CAD, but lacks a prospective design and causal inference; findings in young adults are novel but require validation.
As stated by the source record.
Quoted from the source exactly as published.
These findings suggest that metabolic dysfunction without obesity may confer substantial CAD risk in young adults, warranting investigation of metabolic screening and intervention in this age group. The exploratory phenotypes merit prospective validation before clinical implementation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
The burden of metabolic dysfunction and coronary artery disease (CAD) in young adults has rapidly increased. We aimed to investigate whether the association between metabolically unhealthy status and prevalent CAD varies by age in both obese and non-obese individuals, and whether specific metabolic clustering patterns are associated with an elevated likelihood of obstructive CAD among young adults. This hospital-based study involved patients with and without angiographically confirmed obstructive CAD (coronary stenosis ≥ 50%). The odds ratios (ORs) for CAD associated with metabolically unhealthy non-obesity (MUN) and metabolically unhealthy obesity (MUO) were estimated using multivariate logistic regression analysis across young (age ≤ 45 years), middle-aged (age 46–64 years) and elderly (age ≥ 65 years) adults. The exploratory metabolic clustering analysis included body mass index, mean arterial pressure, triglyceride-to-high-density lipoprotein cholesterol ratio, and glycated hemoglobin. Among 9,051 included participants, obstructive CAD was detected in 3,523 (38.9%) patients. The mean age of the study population was 50.06 ± 15.14 years; 62.1% of them were male and 15.2% were obese. Compared to individuals with metabolically healthy non-obesity, those with MUN and MUO exhibited significantly higher odds of CAD. Notably, young adults demonstrated the strongest associations (MUN: adjusted OR, 5.02 [95% CI 3.24–7.84]; MUO: adjusted OR, 5.06 [95% CI 3.11–8.29]), which were attenuated with aging. Numerical accumulation of metabolically unhealthy components was not only associated with amplified prevalent CAD risk, particularly among young adults, but also positively correlated with atherosclerotic plaque burden among CAD patients (median regression: β = 5.10, P for trend < 0.001). Furthermore, two distinct phenotypes were identified, corresponding to 7.96-fold and 2.35-fold increased odds for the presence of obstructive CAD among young adults, respectively. Metabolically unhealthy status, irrespective of obesity, is associated with a higher prevalence of obstructive CAD with the strongest effect observed among young adults. The two exploratory metabolic clusters showed markedly elevated odds of obstructive CAD in this age group, which warrants further investigation. Trial registration: www.clinicaltrials.gov (NCT 02496858; registration date: July 14, 2015).
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