Association between cardiometabolic phenotypes with atherogenic index of plasma: a cross-sectional study from the Azar Cohort Study

Background: This study was conducted to determine the relationship between cardiometabolic phenotypes and atherogenic index of plasma in the Azar cohort population. Methods: This cross sectional study included 9,515 participants aged 35 to 55, using data from the Azar Cohort Study. Metabolic syndrome was defined based on ATP III criteria. Participants were then classified into four cardiometabolic phenotypes by considering BMI and metabolic syndrome components: metabolically healthy normal weight (MHNW, BMI <25 kg/m2), metabolically unhealthy normal weight (MUHNW, BMI <25 kg/m2), metabolically healthy obese (MHO, BMI >25 kg/m2), and metabolically unhealthy obese (MUHO, BMI>25 kg/m2). AIP was calculated. Result :Among the subjects, 4,801 (50.5%) were metabolically healthy obese (MHO) and 2,680 (28.2%) were metabolically unhealthy obese (MUHO). High-risk AIP levels (>0.21) differed significantly across cardiometabolic phenotypes, with MUHNW (79.6%) and MUHO (64.6%) showing the highest proportions compared to MHNW (13.5%) and MHO (18.6%). After adjusting for confounders, multinomial logistic regression analysis showed individuals in the third tertial of AIP were 103.46 times more likely to be MUHNW (OR = 103.46, 95% CI: 52.82to202.64), 55.77 times more likely to be MUHO (OR = 55.77, 95% CI: 45.65to68.12), and 2.22 times more likely to be MHO (OR = 2.22, 95% CI: 1.91to2.64) compared to the MHNW phenotype (p < 0.001 for all). Conclusion: The study demonstrates significant variation in high risk AIP levels across cardiometabolic phenotypes, emphasizing the need for detailed metabolic health assessments beyond BMI to better predict cardiovascular risk. Keywords: cardiometabolic phenotypes, atherogenic index of plasma, BMI, metabolic health.