Impact of the New EASO Obesity Definition on the Detection of Atheromatosis in Subjects with Low-to-Moderate Cardiovascular Risk

Jose Leon Mengibar^1*Marcelino Bermúdez-Lopez²Jose Manuel Valdivielso³Reinald Pamplona³Gerard Torres²Didac Mauricio⁴Eva Castro²Elvira Fernandez²Assumpta Caixàs⁵Marta Bueno⁶ANDREEA CIUDIN⁷Marta Hernandez⁶Rafael Simó⁷Cristina Hernandez⁷Albert Lecube⁷

• ¹Endocrinology Department Hospital Universitario Arnau de Vilanova, Lérida. Spain, Cardiology Department. Hospital Universitario Arnau de Vilanova, Lérida. Spain., Lerida, Spain
• ²Universitat de Lleida, Lleida, Spain
• ³Universitat de Lleida Departamento de Medicina Experimental, Lleida, Spain
• ⁴Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
• ⁵Fundacio Parc Tauli, Sabadell, Spain
• ⁶Hospital Universitari Arnau de Vilanova, Lleida, Spain
• ⁷Hospital Universitari Vall d'Hebron, Barcelona, Spain

Background: Traditional body mass index (BMI) does not adequately reflect adipose tissue distribution and associated cardiovascular (CV) risk. To improve risk stratification, the European Association for the Study of Obesity (EASO) proposes to extend the diagnostic of obesity including individuals with BMI of 25-30 kg/m², waist-to-height ratio (WtHR) ≥0.5, and any obesity-related complication. Objective: To examine whether this new definition of obesity can better identify the presence of subclinical atheromatosis disease (SAD) in terms of arterial plaque burden compared to the classical BMI-based definition. Methods: Cross-sectional including A total of 8,330 participants from the ILERVAS project (ClinicalTrials.gov Identifier: NCT03228459), aged 45-70 years with low-to-moderate CV risk and no previous CV disease were included. Obesity was classified using traditional (BMI ≥30 kg/m²) and new definitions. Atherosclerosis was assessed through Doppler ultrasound of carotid and femoral arteries. Logistic regression models adjusted for cardiovascular risk factors were used to evaluate associations between obesity definitions and SAD. Results: The new definition increased obesity prevalence from 37.2% to 71.7%. It also revealed higher detection of atheromatous plaques (72.9% vs. 68.6%, p<0.001) and affected more vascular territories. Multivariable analysis showed the new definition independently predicted overall plaque presence (OR 1.54, 95%CI 1.22–1.94, p<0.001) and femoral atherosclerosis (OR 1.36, 95%CI 1.10–1.68, p=0.004). Similar results were obtained when only WtHR was considered, excluding obesity-related complications. Conclusion: The new obesity definition identifies more efficiently individuals at risk for atherosclerosis, especially in the femoral region, compared to classic BMI definition. Further studies to assess cost-effectiveness of this approach seem warranted.