Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis.
Abstract
AIMS: Previous studies have provided inconsistent results about the cardiovascular risks for participants with metabolically healthy obesity (MHO). These uncertainties might partly reflect the lack of a uniform definition of MHO. We conducted a systematic review and meta-analysis to examine whether there is a suitable approach that identifies obese participants who are not at an increased risk of cardiovascular events compared with healthy normal-weight participants. METHODS AND RESULTS: Twenty-two prospective studies were eligible for the meta-analysis. Using random-effect models, pooled relative risks (RRs) were calculated for the combined effects of obesity with the presence or absence of metabolic syndrome, insulin resistance, hypertension, diabetes, hyperlipidaemia and any of these metabolic factors. Participants with MHO defined by the absence of metabolic syndrome were at increased risk for cardiovascular events compared with healthy normal-weight participants (pooled RR 1.45, 95% confidence interval (CI) 1.20-1.70), but had lower risks than unhealthy normal-weight (RR 2.07, 95% CI 1.62-2.65) and obese (RR 2.31, 95% CI 1.99-2.69) participants. The risk associated with participants who had MHO was particularly high over the long term. Similar risk estimates were observed when MHO was defined by other approaches. CONCLUSIONS: None of the approaches clearly identified an obese subgroup not at increased risk of cardiovascular events compared with normal-weight healthy participants. A benign obese phenotype might be defined by strict definitions, but insufficient studies exist to support this. More research is needed to better define MHO.
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GLP-1 receptor agonists were historically approved exclusively to treat type 2 diabetes, but recent clinical trials concluded they are highly effective at weight management and cardiovascular disease prevention, leading to FDA approvals for these indications.
“Historically, GLP-1 receptor agonists were exclusively approved to treat type 2 diabetes, but recent clinical trials concluded that they are highly effective at weight management and cardiovascular disease prevention, leading to US Food and Drug Administration (FDA) approvals for these indications.3”
From Factors Associated With Semaglutide Initiation Among Adults With Obesity (2025) · cites this paper as [3]
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- Authors
- Eckel, N., Meidtner, K., Kalle-Uhlmann, T., Stefan, N., & Schulze, M. B.
- Affiliations
- German Center for Diabetes Research (DE)
- German Institute of Human Nutrition (DE)
- Helmholtz Munich (DE)
- Corresponding author
- Schulze, Matthias B
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-06-01
- Volume
- 23
- Issue
- 9
- Pages
- 956-966
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W2201485362
- Cited by
- 405
- References
- 64
- Citations by year
- 2026: 26 · 2025: 41 · 2024: 37 · 2023: 48 · 2022: 52 · 2021: 52 · 2020: 44 · 2019: 38 · 2018: 37 · 2017: 24 · 2016: 6
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Site cant be reached (submittedVersion)
- 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 events, cardiovascular risk, metabolic syndrome, insulin resistance, hypertension, diabetes mellitus, hyperlipidemia, obesity phenotypes
- MeSH terms
- Obesity, Metabolically Benign, Cardiovascular Diseases, Humans, Phenotype, Prognosis, Risk Factors, Odds Ratio, Risk Assessment
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