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J Am Coll Cardiol. 2018 May 1;71(17):1857-1865. doi: 10.1016/j.jacc.2018.02.055.

Metabolically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk.

Author information

1
Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: mmongraw@wakehealth.edu.
2
Duke-NUS Medical School, Singapore.
3
Department of Family Medicine and Public Health, University of California-San Diego, La Jolla, California; Department of Medicine, University of California-San Diego, La Jolla, California; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
4
Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
5
New York University School of Medicine, New York, New York.
6
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
7
Great Point Health, Portland, Oregon.
8
Departments of Pathology & Laboratory Medicine and Biochemistry, Larner College of Medicine at the University of Vermont, Colchester, Vermont.
9
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland; The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of New South Wales, Australia.
10
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.

Abstract

BACKGROUND:

Debate over the cardiometabolic risk associated with metabolically healthy obesity (MHO) continues. Many studies have investigated this relationship by examining MHO at baseline with longitudinal follow-up, with inconsistent results.

OBJECTIVES:

The authors hypothesized that MHO at baseline is transient and that transition to metabolic syndrome (MetS) and duration of MetS explains heterogeneity in incident cardiovascular disease (CVD) and all-cause mortality.

METHODS:

Among 6,809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) the authors used Cox proportional hazards and logistic regression models to investigate the joint association of obesity (≥30 kg/m2) and MetS (International Diabetes Federation consensus definition) with CVD and mortality across a median of 12.2 years. We tested for interaction and conducted sensitivity analyses for a number of conditions.

RESULTS:

Compared with metabolically healthy normal weight, baseline MHO was not significantly associated with incident CVD; however, almost one-half of those participants developed MetS during follow-up (unstable MHO). Those who had unstable MHO had increased odds of CVD (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.14 to 2.25), compared with those with stable MHO or healthy normal weight. Dose response for duration of MetS was significantly and linearly associated with CVD (1 visit with MetS OR: 1.62; 95% CI: 1.27 to 2.07; 2 visits, OR: 1.92; 95% CI: 1.48 to 2.49; 3+ visits, OR: 2.33; 95% CI: 1.89 to 2.87; p value for trend <0.001) and MetS mediated approximately 62% (44% to 100%) of the relationship between obesity at any point during follow-up and CVD.

CONCLUSIONS:

Metabolically healthy obesity is not a stable or reliable indicator of future risk for CVD. Weight loss and lifestyle management for CVD risk factors should be recommended to all individuals with obesity.

KEYWORDS:

cardiovascular disease; epidemiology; metabolic syndrome; metabolically healthy obesity; mortality; obesity

PMID:
29699611
PMCID:
PMC6002856
DOI:
10.1016/j.jacc.2018.02.055
[Indexed for MEDLINE]
Free PMC Article

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