CVD risk persists in ‘metabolically healthy’ adults with obesity

Adults with obesity deemed to be “metabolically healthy” remained at increased risk for developing cardiovascular disease when compared with adults with normal weight and no metabolic abnormalities, according to findings presented at the European Congress on Obesity.

“At the population-level, so-called metabolically healthy obesity is not a harmless condition,” Rishi Caleyachetty, MBBS, PhD, an epidemiologist at the Institute of Applied Health Research, College of Medical and Dental Sciences at the University of Birmingham, United Kingdom, said in a press release. “Perhaps it is better not to use this term to describe an obese person, regardless of how many metabolic complications they have.”

Caleyachetty and colleagues analyzed electronic health records from 3.5 million adults free from CVD at baseline, beginning in 1995. Researchers stratified the cohort according to BMI and the presence or absence of three metabolic abnormalities: diabetes, hypertension and hyperlipidemia, which were combined to create a metabolic abnormalities score (0, 1, 2 and 3). Adults with obesity and a score of 0 were considered to be metabolically healthy.

Researchers examined whether the risk for developing four CV conditions — coronary heart disease, cerebrovascular disease, heart failure and peripheral vascular disease — was different for normal-weight people with no metabolic conditions or people with obesity who were metabolically healthy.

Compared with normal-weight adults, individuals with obesity and no metabolic abnormalities had a 50% increased risk for CHD, a 7% increased risk for cerebrovascular disease and a doubled risk for heart failure. Results persisted after adjusting for demographics and smoking status.

Against these trends, metabolically healthy individuals with obesity had a 9% lower risk for peripheral vascular disease, the researchers added; however, in further analyses that excluded cigarette smokers, individuals with obesity who were metabolically healthy had an 11% increased risk for developing peripheral vascular disease compared with those of normal weight with no metabolic abnormalities.

With each additional metabolic abnormality observed in adults with obesity, researchers found that the risk for CVD events increased. Compared with a normal-weight adult with no metabolic abnormalities, a person with obesity and three metabolic abnormalities had a 2.6 times increased risk for CHD; a 58% increased risk for cerebrovascular disease, including stroke; a 3.8 times increased risk for heart failure; and a 2.2 times increased risk for peripheral vascular disease.

“This is the largest prospective study of the association between metabolically healthy obesity and [CVD] events,” Caleyachetty said in the release. “Metabolically healthy obese individuals are at higher risk of [CHD], cerebrovascular disease and heart failure than normal-weight metabolically healthy individuals. The priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities.” – by Regina Schaffer

Reference:

Caleyachetty R, et al. OS2:OC54. Presented at: European Congress on Obesity; May 17-20, 2017; Porto, Portugal.

Disclosure: The researchers report no relevant financial disclosures.