LIPID METABOLISM DISORDERS AND THE DIAGNOSTIC SIGNIFICANCE OF ATHEROGENIC INDICES IN OBESITY

Obesity has reached pandemic proportions globally and serves as a primary etiological driver of premature cardiovascular morbidity and mortality through complex alterations in systemic lipid and lipoprotein homeostasis. While conventional lipid profiling focuses predominantly on isolated measurements of total cholesterol and low-density lipoprotein cholesterol, these traditional parameters frequently fail to capture the profound qualitative and structural lipoprotein abnormalities characteristic of adiposity, such as the accumulation of small dense low-density lipoprotein particles and triglyceride-rich lipoprotein remnants. This comprehensive clinical-biochemical study evaluates the diagnostic and prognostic utility of composite atherogenic indices—specifically the Atherogenic Index of Plasma, Castelli Risk Index-I, Castelli Risk Index-II, and the Atherogenic Coefficient—in stratifying subclinical cardiovascular risk among individuals across different grades of obesity. A cohort of patients with clinically confirmed class one, class two, and class three obesity was systematically investigated alongside an age- and sex-matched normoweight control group. In addition to standard enzymatic lipid profiling and apolipoprotein quantification, comprehensive mathematical lipid ratios were calculated and correlated with markers of visceral adiposity and carotid intima-media thickness assessed via high-resolution ultrasonography. The results demonstrate that while nearly one-third of obese patients exhibited borderline or seemingly normal isolated low-density lipoprotein cholesterol concentrations, their calculated atherogenic indices were markedly and statistically significantly elevated compared to healthy controls. The Atherogenic Index of Plasma exhibited the strongest positive linear correlation with visceral waist circumference, hepatic insulin resistance, and subclinical carotid wall thickening, achieving superior diagnostic sensitivity and specificity in receiver operating characteristic curve analysis compared to any single lipid parameter. The study concludes that integrating composite atherogenic indices into routine biochemical evaluations provides an inexpensive, highly sensitive, and mathematically robust clinical tool for unmasking occult atherogenic dyslipidemia and guiding early preventive pharmacotherapy in obese populations.