The presence of metabolic syndrome conferred a 2.5-fold higher heart failure risk (HR 2.5; 95% CI 1.68-3.40), whereas metabolically healthy obese individuals showed decreased risk.
Cohort (n=550)
Does the metabolically healthy obese phenotype prevent heart failure in individuals without diabetes or baseline macrovascular complications compared to normal-weight individuals with metabolic syndrome?
Metabolically healthy obese individuals have a decreased risk of heart failure compared to normal-weight individuals with metabolic syndrome, highlighting the importance of metabolic health over BMI alone.
Effect estimate: HR 2.5 (95% CI 1.68-3.40)
OBJECTIVES: The purpose of this study was to assess whether the metabolically healthy obese phenotype is associated with lower heart failure (HF) risk compared with normal-weight individuals with metabolic syndrome (MetS). BACKGROUND: Obesity and MetS often coexist and are associated with increased HF risk. It is controversial whether obese individuals with normal insulin sensitivity have decreased HF risk. METHODS: A total of 550 individuals without diabetes or baseline macrovascular complications were studied during a median follow-up of 6 years. Participants were classified by presence (n = 271) or absence (n = 279) of MetS and by body mass index (body mass index: <25 kg/m(2) = normal weight, n = 177; 25 to 29.9 kg/m(2) = overweight, n = 234; ≥ 30 kg/m(2) = obese, n = 139). MetS was diagnosed with the National Cholesterol Education Program Adult Treatment Panel III criteria. Left ventricular functional capacity, myocardial structure, and performance were assessed echocardiographically. RESULTS: Body mass index was not associated with increased HF risk. The presence of MetS conferred a 2.5-fold higher HF risk (hazard ratio HR: 2.5, 95% confidence interval CI: 1.68 to 3.40). Overweight and obese individuals without MetS had the lowest 6-year HF risk (HR: 1.12, 95% CI: 0.35 to 1.33 corrected and HR: 0.41, 95% CI: 0.10 to 1.31, respectively) compared with normal-weight individuals with MetS (HR: 2.33, 95% CI: 1.25 to 4.36, p < 0.001). From the individual components of MetS, impaired fasting glucose (HR: 1.09, 95% CI: 1.06 to 1.10), high BP (HR: 2.36, 95% CI: 1.03 to 5.43), low high-density lipoprotein cholesterol (HR: 1.88, 95% CI: 1.29 to -2.77), and central obesity (HR: 2.22, 95% CI: 1.02 to 1.05) were all associated with increased HF risk. Factors commonly associated with MetS such as insulin resistance and inflammation (high-sensitivity C-reactive protein and microalbuminuria) were also independently associated with HF incidence. CONCLUSIONS: In contrast to normal weight insulin-resistant individuals, metabolically healthy obese individuals show decreased HF risk in a 6-year follow-up study.
Voulgari et al. (Thu,) conducted a cohort in Metabolic syndrome and obesity (n=550). Metabolically healthy obesity (without metabolic syndrome) vs. Normal-weight with metabolic syndrome was evaluated on Heart failure (HR 2.5, 95% CI 1.68-3.40). The presence of metabolic syndrome conferred a 2.5-fold higher heart failure risk (HR 2.5; 95% CI 1.68-3.40), whereas metabolically healthy obese individuals showed decreased risk.
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