{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:04:30Z","timestamp":1789589070338,"version":"build-2803163510"},"reference-count":55,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["ATVB"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Carotid plaque vulnerability, driven by metabolic dysfunction and obesity, is a critical determinant of ischemic stroke risk. However, the heterogeneity of obesity phenotypes\u2014defined by metabolic health\u2014remains 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>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\u2014intraplaque hemorrhage (IPH), lipid-rich necrotic core, and fibrous cap rupture\u2014across 4 obesity phenotype subgroups: metabolically healthy normal weight (MHNW), metabolically abnormal normal weight, metabolically healthy obese (MHO), and metabolically abnormal obese (MAO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      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;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002) and IPH (17.1% versus 10.1% in MHNW;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) in the MAO group were higher than those in the MHNW and MHO groups (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). The MHO group exhibited plaque stability similar to MHNW, whereas metabolically abnormal normal weight had greater maximum wall thickness (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004) than MHO and higher IPH prevalence than MHNW (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.054). Several carotid plaque morphological variables significantly differed among the 4 groups (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). In further adjusted logistic regression models, MAO was independently associated with IPH (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.015), alongside male sex, advanced age, and antihypertensive agent use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>This study redefines the role of obesity in atherosclerosis by prioritizing metabolic health over body mass index, demonstrating that MAO is independently associated with IPH and exhibits elevated high-risk carotid plaque\/IPH prevalence versus MHNW\/MHO. The robustness of IPH as a metabolic instability indicator warrants particular attention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02017756.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/atvbaha.125.323413","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T09:00:14Z","timestamp":1758186014000},"page":"2097-2108","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Metabolically Abnormal Obesity and Carotid Plaque Vulnerability: A Vessel Wall MRI Study 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