Author + information
- Received March 5, 2017
- Revision received July 18, 2017
- Accepted July 19, 2017
- Published online September 11, 2017.
- Rishi Caleyachetty, MBBS, PhDa,
- G. Neil Thomas, PhDa,∗ (, )
- Konstantinos A. Toulis, MD, PhDa,b,
- Nuredin Mohammed, PhDa,
- Krishna M. Gokhale, MSca,
- Kumarendran Balachandran, MBBS, MDa,c and
- Krishnarajah Nirantharakumar, MPH, MDa
- aInstitute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- bDepartment of Endocrinology, General Military Hospital, Thessaloniki, Greece
- cDepartment of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- ↵∗Address for correspondence:
Prof. G. Neil Thomas, Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 5, 2017.
- Revision received July 18, 2017.
- Accepted July 19, 2017.
- 2017 American College of Cardiology Foundation