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Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women

Published on Sep 19, 2017in Journal of the American College of Cardiology18.639
· DOI :10.1016/J.JACC.2017.07.763
Rishi Caleyachetty10
Estimated H-index: 10
(University of Birmingham),
G. Neil Thomas39
Estimated H-index: 39
(University of Birmingham)
+ 4 AuthorsKrishnarajah Nirantharakumar18
Estimated H-index: 18
(University of Birmingham)
Sources
Abstract
Abstract 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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  • Citations (141)
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References37
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#1A J Tomiyama (UCLA: University of California, Los Angeles)H-Index: 2
#2Jeffrey M. Hunger (UCSB: University of California, Santa Barbara)H-Index: 11
Last. Christine Wells (UCLA: University of California, Los Angeles)H-Index: 5
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International Journal of Obesity accepted article preview online, 02 May 2016. doi:10.1038/ijo.2016.83.
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The United States Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30% of health insurance costs if they fail to meet 'health' criteria, such as reaching a specified body mass index (BMI). Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005-2012 National Health and Nutrition Examination Survey. Using the...
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#2Dan Zhou (ZJU: Zhejiang University)H-Index: 4
Last. Yimin Zhu (ZJU: Zhejiang University)H-Index: 20
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Background Metabolically healthy obese phenotype (MHO) refers to obese individuals with absence of metabolic abnormalities such as dyslipidaemia, insulin resistance and hypertension. Many studies reported the long-term prognosis of MHO on diseases and mortality with inconsistent results. Methods We performed a meta-analysis to assess the risks of cardiovascular (CV) events and all-cause mortality for MHO individuals. Original prospective observational studies were searched in Medline, EMBASE, We...
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Some obese persons do not develop (at least in the short term) the metabolic complications of obesity that are thought to be causally linked to cardiovascular events or premature mortality. This phenomenon has been termed "metabolically healthy obesity" (MHO), and it has received much attention recently, to the extent that some authors argue that "new metrics" must be developed to estimate the risk associated with obesity beyond body mass index. In this commentary, we argue that the MHO phenotyp...
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The fraction of the obese population who appear to be free of the metabolic abnormalities that usually accompany excess adiposity has garnered a great deal of attention recently. The so-called “metabolically healthy obesity” concept is thought to offer a refinement of the traditional obesity definitions that are based solely on anthropometry. The commentary by Rey-Lopez et al. (Am J Epidemiol. 2015;182(9):737–741) in this issue of the Journal highlights several limitations of the “metabolically ...
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Last. A J TomiyamaH-Index: 2
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A letter to the editor is presented in response to the article "Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records" by A. Fildes, J. Charlton, C. Rudisill, P. Littlejohns, A.T. Prevost, and M.C. Gulliford which appears in a 2015 issue.
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BACKGROUND Data suggest that metabolic health status, incorporating components of metabolic syndrome (MetS), predicts cardiovascular disease (CVD) risk better than body mass index (BMI). This study explored the association of MetS and obesity with endothelial function. METHODS Forty-four participants were phenotyped according to BMI as non-obese vs. obese ( 30 kg/m2) and according to the International Diabetes Federation criteria of MetS: ≤2 criteria MetS (MetS-) vs. ≥3 criteria MetS (MetS+); i)...
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