CVD risk increases with transition to metabolically unhealthy obesity

Adults who transition from metabolically healthy obesity to metabolically unhealthy obesity are at increased risk for cardiovascular disease compared with metabolically healthy individuals with normal weight, according to findings published in Metabolism.

“Most recent meta-analytic findings corroborate that metabolically benign obesity may in fact not be an innocuous low-risk condition as previously believed, underscoring that former literature provides inadequate evidence with regard to the elevated CVD risk which it may propagate,” Demosthenes B. Panagiotakos, DrMed, a professor of biostatistics, research methods and epidemiology in the department of nutrition and dietetics at the School of Health Science and Education at Harokopio University in Athens, Greece, and colleagues wrote.

Panagiotakos and colleagues analyzed data from 1,890 adults (50.2% women) who participated in the ATTICA study, a prospective observational study begun in 2001. Researchers recorded BMI and metabolic status for all participants at baseline. Obesity was defined as BMI at least 30 kg/m². Panagiotakos and colleagues utilized a strict definition of metabolic status, which required the absence of hypertension, dyslipidemia and glycemic abnormalities, as well as any associated medications for such conditions. Diet quality was assessed based on adherence to a Mediterranean diet, which was measured by MedDietScore; a score of 27 or lower was considered nonadherent.

Four groups were created from these baseline measurements: metabolically healthy normal weight (n = 686; 60% women; mean age, 38 years), metabolically healthy obesity (n = 107; 50% women; mean age, 45 years), metabolically unhealthy normal weight (n = 672; 46% women; mean age, 50 years) and metabolically unhealthy obesity (n = 425; 42% women; mean age, 52 years).

Follow-up examinations were conducted at 5 and 10 years after baseline. The researchers’ primary endpoints were CVD events, which included acute myocardial infarction, unstable angina, heart failure, chronic arrhythmias and stroke. Metabolic status was also determined at each follow-up examination.

A total of 107 participants had metabolically healthy obesity at baseline. The 10-year event rate for all participants was 15.7%. At 10 years, participants with metabolically healthy obesity had a CVD event rate 2.66 times higher than participants with metabolically healthy normal weight (P < .001). However, the CVD event rate was 1.25 times to 1.56 times lower for participants with metabolically healthy obesity vs. those with metabolically unhealthy obesity (P < .001).

Although persistent metabolically healthy obesity was linked to lower CVD event rates compared with metabolically unhealthy obesity, 55.1% of participants who had metabolically healthy obesity at baseline developed metabolically unhealthy obesity at 10 years. The researchers specifically noted that 24 of the 107 participants who began with metabolically healthy obesity reached the highest disease risk burden, which was defined as the presence of abnormal glycemic, lipid and blood pressure profiles.

“This is in line with the hitherto evidence yet comes to highlight that even the ‘healthiest’ obese confer a high risk to develop conventional risk factors and become [metabolically unhealth obesity] later in their life,” the researchers wrote.

The researchers further noted that transitioning from metabolically healthy obesity to metabolically unhealthy obesity was independently associated with higher CVD risk (HR = 1.43; 95% CI, 1.02-2.01) compared with metabolically healthy normal weight, which was used as reference.

For participants who retained metabolically healthy obesity status, a positive association with 10-year CVD event rates was found in women (HR = 2.01; 95% CI, 1.34-3.49), participants who did not adhere to a Mediterranean diet (HR = 1.14; 95% CI, 1-2.35) and participants with insulin resistance (HR = 1.75; 95% CI, 1.2-3.76).

“Our findings suggest that primary prevention strategies and constant vigilance may be necessary in [metabolically healthy obesity] persons so as to deter transitions to [metabolic syndrome] and subsequent increased CVD risk,” the researchers wrote. “Concomitantly, our findings suggest that further efforts should focus on apparently ‘persistent’ [metabolically healthy obesity] subjects. In light of this perspective, appropriately defining the subset of obese persons who are ‘over time’ resilient to metabolic abnormalities, as well as identifying their particular features, is mandated for identifying those at lowest risk of adverse health outcomes, including CVD.” – by Phil Neuffer

Disclosure s : The authors report no relevant financial disclosures.

1/11/2019