Key result
Metabolically healthy obesity is linked to ~49% higher CHD risk versus healthy normal weight.
Why the study?
Previous studies have been unclear about the cardiovascular risks for metabolically healthy obese individuals.
Does metabolically healthy obesity increase the risk of incident cardiovascular disease events compared to normal weight without metabolic abnormalities in adults initially free of cardiovascular disease?
Cohort (n=3,500,000)
Does metabolically healthy obesity increase the risk of incident cardiovascular disease events compared to normal weight without metabolic abnormalities in adults initially free of cardiovascular disease?
Hazard Ratio: 1.49 (95% CI 1.45–1.54)
Metabolically healthy obesity is not a benign condition, as it significantly increases the risk of incident coronary heart disease, cerebrovascular disease, and heart failure compared to metabolically healthy normal-weight individuals.
BACKGROUND: Previous studies have been unclear about the cardiovascular risks for metabolically healthy obese individuals. OBJECTIVES: This study examined the associations among metabolically healthy obese individuals and 4 different presentations of incident cardiovascular disease in a contemporary population. METHODS: We used linked electronic health records (1995 to 2015) in The Health Improvement Network (THIN) to assemble a cohort of 3.5 million individuals, 18 years of age or older and initially free of cardiovascular disease. We created body size phenotypes defined by body mass index categories (underweight, normal weight, overweight, and obesity) and 3 metabolic abnormalities (diabetes, hypertension, and hyperlipidemia). The primary endpoints were the first record of 1 of 4 cardiovascular presentations (coronary heart disease [CHD], cerebrovascular disease, heart failure, and peripheral vascular disease). RESULTS: During a mean follow-up of 5.4 years, obese individuals with no metabolic abnormalities had a higher risk of CHD (multivariate-adjusted hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.45 to 1.54), cerebrovascular disease (HR: 1.07; 95% CI: 1.04 to 1.11), and heart failure (HR: 1.96; 95% CI: 1.86 to 2.06) compared with normal weight individuals with 0 metabolic abnormalities. Risk of CHD, cerebrovascular disease, and heart failure in normal weight, overweight, and obese individuals increased with increasing number of metabolic abnormalities. CONCLUSIONS: Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities and similar risks for cardiovascular disease events.
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Caleyachetty et al. (2017) conducted a cohort in Cardiovascular disease (n=3,500,000). Obesity with no metabolic abnormalities vs. Normal weight individuals with 0 metabolic abnormalities was evaluated on First record of coronary heart disease, cerebrovascular disease, heart failure, or peripheral vascular disease (HR 1.49, 95% CI 1.45 to 1.54). Metabolically healthy obese individuals had a higher risk of coronary heart disease (HR 1.49; 95% CI 1.45-1.54) compared with normal weight individuals with no metabolic abnormalities.