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Risk for CHD, HF, cerebrovascular disease increases in metabolically healthy obese
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Patients who were metabolically healthy obese had a higher risk for CHD, HF and cerebrovascular disease compared with those who were normal weight and metabolically healthy, according to a study published in the Journal of the American College of Cardiology.
“This is the largest prospective study of the association between body size phenotypes, including metabolically healthy obesity, with or without metabolic abnormalities and a range of [CV] events,” Rishi Caleyachetty, MBBS, PhD, research fellow at the Institute of Applied Health Research at the University of Birmingham in the United Kingdom, said in a press release.
Patients without CVD events
Researchers reviewed electronic health records from 3,495,777 patients aged 18 years and older who were free from CVD events from January 1995 to September 2015. Metabolic abnormalities — diabetes, hypertension and hyperlipidemia — were also analyzed.
Patients were categorized by body phenotypes, including underweight (BMI < 18.5 kg/m2), normal weight (BMI 18-25 kg/m2), overweight (BMI 25-30 kg/m2) and obese (BMI 30 kg/m2). Follow-up occurred for a mean of 5.4 years.
Outcomes of interest included the first record of one of the following CVD presentations: cerebrovascular disease, CHD, peripheral vascular disease and HF.
Of patients with no metabolic abnormalities, 2.7% were underweight, 37.7% were normal weight, 25.7% were overweight and 14.8% were obese.
Compared with patients who were metabolically unhealthy and obese, those who were metabolically healthy and obese were more likely to be men, younger, socioeconomically deprived and current smokers.
Increased risk for endpoints
After adjusting for potential confounders, patients who were obese with no metabolic abnormalities had an increased risk for CHD (HR = 1.49; 95% CI, 1.45-1.54), HF (HR = 1.96; 95% CI, 1.86-2.06) and cerebrovascular disease (HR = 1.07; 95% CI, 1.04-1.11) compared with those who were of normal weight with no metabolic abnormalities.
The risk for CHD, HF and cerebrovascular disease in patients in the normal, overweight and obese groups increased as the number of metabolic abnormalities increased.
After adjusting for confounders, among those with no metabolic abnormalities, compared with those of normal weight, patients who were underweight had an increased risk for peripheral vascular disease (HR = 1.49; 95% CI, 1.36-1.63) but patients who were obese (HR = 0.91; 95% CI, 0.86-0.96) and overweight (HR = 0.92; 95% CI, 0.88-0.96) had decreased risk. The risk for peripheral vascular disease increased in patients in the normal, overweight and obese groups as the number of metabolic abnormalities increased.
“Clinicians need to be aware that individuals who would otherwise be considered nonobese based on a normal BMI can have metabolic abnormalities and therefore also be at high risk for CVD events,” Caleyachetty and colleagues wrote.
“The study not only definitively countered the concept of metabolically benign obesity, but also demonstrated great risk to normal-weight individuals if metabolic dysfunction is present,” Jennifer W. Bea, PhD, assistant professor/research scholar in medicine, associate in extension, nutritional sciences and academic and research coordinator of the R25T Cancer Prevention and Control Translational Research Training Program at the University of Arizona Cancer Center in Tucson, and Nancy K. Sweitzer, MD, PhD, director of the University of Arizona Sarver Heart Center in Tucson, and chief of the division of cardiology and professor of medicine at the University of Arizona College of Medicine-Tucson, wrote in a related editorial. “Thus, we would suggest an increased need for screening in the normal-weight population.” – by Darlene Dobkowski
Disclosures: All authors report no relevant financial disclosures.
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