Cited by 574Diabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Disease and AdiposityCardiovascular Function and Risk Factors

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

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Caleyachetty, Rishi, Thomas, G. Neil, Toulis, Konstantinos A., Mohammed, Nuredin, Gokhale, Krishna M., Balachandran, Kumarendran, Nirantharakumar, Krishnarajah·2017·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2017.07.763

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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.

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“…with MHO may still have a higher long-term risk of cardiovascular disease and mortality than metabolically healthy normal-weight individuals (33), while longitudinal studies suggest that many transition to metabolically unhealthy states over time, with adverse cardiovascular consequences (34, 35).”
Ultrasound-defined fatty liver and the risk of progression from preclinical to clinical obesity: a prospective cohort study
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“…obesity classified as “metabolically healthy” remain at increased risk compared with individuals with normal weight and without metabolic risk factors, including a 49% higher risk of coronary heart disease, a 7% higher risk of cerebrovascular disease, and a 96% higher risk of heart failure (12).”
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Authors: Caleyachetty, R., Thomas, G. N., Toulis, K. A., Mohammed, N., Gokhale, K. M., Balachandran, K., & Nirantharakumar, K.
Affiliations: University of Birmingham (GB)
424 General Military Hospital (GR)
Corresponding author: Thomas, G. Neil
ORCID: Caleyachetty, Rishi
Thomas, G. Neil
Toulis, Konstantinos A.
Mohammed, Nuredin
Gokhale, Krishna M.
Nirantharakumar, Krishnarajah
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2017-09
Volume: 70
Issue: 12
Pages: 1429-1437
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2017.07.763
OpenAlex: W2755267305
Cited by: 574
References: 37
Citations by year: 2026: 48 · 2025: 65 · 2024: 73 · 2023: 60 · 2022: 71 · 2021: 68 · 2020: 66 · 2019: 51 · 2018: 64 · 2017: 8
FWCI: 40.67
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 383 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc-nd)
Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
Funders: Medical Research Council (MC_PC_15079)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords: metabolically healthy obesity, cardiovascular risk, coronary artery disease, cerebrovascular disease, heart failure, peripheral vascular disease, body mass index, metabolic abnormalities, diabetes mellitus, hypertension, hyperlipidemia, normal-weight individuals
MeSH terms: Adult, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Obesity, Prospective Studies, Incidence, Risk Assessment

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

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