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May 12, 2020Metabolic Syndrome and Related Disorders

Impact of the Definition of Metabolically Healthy Obesity on the Association with Incident Cardiovascular Disease

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Why the study?

Whether individuals with metabolically healthy obesity have an increased risk of CVD is controversial, potentially due to differences in how MHO is defined.

Does the presence of Metabolic Syndrome risk factors increase the risk of incident cardiovascular disease in overweight and obese men?

Population

2122 men aged 50 years in the ULSAM cohort

Comparison

Obese, overweight, and normal weight individuals subdivided by number of MetS risk factors

Design

Cohort study

Follow-up

Median 28.0 years

Authors

LLLars LindURUlf RisérusJÄJohan Ärnlöv

Discussion

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Overview

Definition-dependent MHO-CVD risk estimates warrant caution in phenotyping; leaves open whether any truly benign obese subgroup exists.

Key Points

  • To determine how varying definitions of metabolically healthy obesity, categorized by the number of Metabolic Syndrome components, influence the long-term risk of incident cardiovascular disease.
  • Analyzed 2,122 adult men (mean age 50 years; 1,143 normal weight, 845 overweight, 134 obese) from the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort over a median follow-up of 28.0 years.
  • Classified participants by body mass index and the number of Metabolic Syndrome risk factors (excluding waist circumference), monitoring 877 incident cardiovascular disease events defined as fatal or nonfatal myocardial infarction, stroke, or heart failure.
  • Compared to normal-weight men without Metabolic Syndrome risk factors (n=235), obese men with one risk factor had significantly elevated cardiovascular risk (HR 3.0, 95% CI 1.7–5.3, P=0.0002), which increased to HR 5.5 (95% CI 3.0–9.8, P<0.00001) in those with four risk factors.
  • Obese men with zero Metabolic Syndrome risk factors exhibited no increased risk but were very rare (n=3), while overweight men without risk factors (n=74) had risk rates similar to the healthy normal-weight reference group.

Structured PICO

Does the presence of Metabolic Syndrome risk factors increase the risk of incident cardiovascular disease in overweight and obese men?

P
Population
2,122 adult men from the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, mean age 50 years, including obese (n=134), overweight (n=845), and normal weight (n=1143) individuals.
I
Intervention
Obesity or overweight with varying numbers of Metabolic Syndrome (MetS) risk factors
C
Comparator
Normal weight individuals without any Metabolic Syndrome (MetS) risk factors (n=235)
O
Outcome
Incident cardiovascular disease event (composite of fatal or nonfatal myocardial infarction, stroke, or heart failure) at median 28.0 years follow-upcomposite

The risk of cardiovascular disease in obesity is highly dependent on the presence of metabolic syndrome risk factors, with truly 'metabolically healthy' obesity being extremely rare but not associated with increased risk.

Cite This Study

Lind et al. (2020) studied this question.

synapsesocial.com/papers/6a7cd0d7e4005ef081adc847https://doi.org/10.1089/met.2020.0016
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impact of Body Mass Index and the Metabolic Syndrome on the Risk of Cardiovascular Disease and Death in Middle-Aged Men2009 · 625 citations
  2. 2The Metabolically Healthy but Obese Individual Presents a Favorable Inflammation Profile2005 · 579 citations
  3. 3Insulin resistance syndrome, body mass index and the risk of ischemic heart disease2005 · 147 citations
  4. 4Harmonizing the Metabolic Syndrome2009 · 14,973 citations
  5. 5The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering2008 · 1,615 citations