Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women

Rishi Caleyachetty; G. Neil Thomas; Konstantinos A. Toulis; Nuredin Mohammed; Krishna M. Gokhale; Kumarendran Balachandran; Krishnarajah Nirantharakumar

doi:10.1016/j.jacc.2017.07.763

Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women

Rishi Caleyachetty, G. Neil Thomas^*, Konstantinos A. Toulis, Nuredin Mohammed, Krishna M. Gokhale, Kumarendran Balachandran, Krishnarajah Nirantharakumar

^*Corresponding author for this work

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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.

Original language	English
Pages (from-to)	1429-1437
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	70
Issue number	12
Early online date	11 Sept 2017
DOIs	https://doi.org/10.1016/j.jacc.2017.07.763
Publication status	Published - 19 Sept 2017

Keywords

cerebrovascular disease
coronary heart disease
heart failure
obesity
overweight
phenotype
weight

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

@article{11555c772ea345869a11b870b1d063cf,

title = "Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women",

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.",

keywords = "cerebrovascular disease, coronary heart disease, heart failure, obesity, overweight, phenotype, weight",

author = "Rishi Caleyachetty and Thomas, {G. Neil} and Toulis, {Konstantinos A.} and Nuredin Mohammed and Gokhale, {Krishna M.} and Kumarendran Balachandran and Krishnarajah Nirantharakumar",

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AU - Thomas, G. Neil

AU - Toulis, Konstantinos A.

AU - Mohammed, Nuredin

AU - Gokhale, Krishna M.

AU - Balachandran, Kumarendran

AU - Nirantharakumar, Krishnarajah

PY - 2017/9/19

Y1 - 2017/9/19

N2 - 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.

AB - 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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ER -

Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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