Dataset Information

Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.

ABSTRACT: Aims:The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study. Methods and results:We conducted a case-cohort analysis in the 520?000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2?years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as???3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Conclusion:Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.

SUBMITTER: Lassale C

PROVIDER: S-EPMC6198928 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.

Lassale Camille C Tzoulaki Ioanna I Moons Karel G M KGM Sweeting Michael M Boer Jolanda J Johnson Laura L Huerta José María JM Agnoli Claudia C Freisling Heinz H Weiderpass Elisabete E Wennberg Patrik P van der A Daphne L DL Arriola Larraitz L Benetou Vassiliki V Boeing Heiner H Bonnet Fabrice F Colorado-Yohar Sandra M SM Engström Gunnar G Eriksen Anne K AK Ferrari Pietro P Grioni Sara S Johansson Matthias M Kaaks Rudolf R Katsoulis Michail M Katzke Verena V Key Timothy J TJ Matullo Giuseppe G Melander Olle O Molina-Portillo Elena E Moreno-Iribas Concepción C Norberg Margareta M Overvad Kim K Panico Salvatore S Quirós J Ramón JR Saieva Calogero C Skeie Guri G Steffen Annika A Stepien Magdalena M Tjønneland Anne A Trichopoulou Antonia A Tumino Rosario R van der Schouw Yvonne T YT Verschuren W M Monique WMM Langenberg Claudia C Di Angelantonio Emanuele E Riboli Elio E Wareham Nicholas J NJ Danesh John J Butterworth Adam S AS

European heart journal 20180201 5

<h4>Aims</h4>The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.<h4>Methods and results</h4>We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident corona ...[more]

PMID: 29020414

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Project description:AimsThe association of strictly defined metabolic healthy obese (MHO) with subclinical cardiac function was unclear. Our study aims to examine the role of MHO in subclinical cardiac dysfunction in a Chinese population.Methods and resultsThe study subjects were recruited from Danyang from 2017 to 2019. Obesity was defined by body mass index (BMI) categories (normal weight, overweight and obesity). Metabolic health was strictly defined as having neither any of the guidelines recommended metabolic syndrome components nor insulin resistance. Thus, subjects were grouped by BMI categories and metabolic health status as six groups. Preclinical systolic (global longitudinal strain [GLS]) and diastolic function were assessed by 2D speckle tracking, and transmitral and tissue Doppler imaging, respectively. The 2757 participants (mean age ± standard deviation, 52.7 ± 11.7 years) included 1613 (58.5%) women, 999 (36.2%) obese, 2080 (75.4%) metabolically unhealthy and 93 (3.4%) MHO participants. After adjustment for covariates, the trend was similar for left ventricular (LV) ejection fraction (Ptrend ≥ 0.07) but significantly worse for GLS, e' and E/e' (Ptrend ≤ 0.02) across the six groups or passing from normal weight to obese individuals irrespective of metabolic status. MHO participants had lower GLS (20.4 vs. 21.4%) and e' (9.6 vs. 10.6 cm/s) compared with controls (P < 0.0001) but had similar GLS (P = 0.47) compared with metabolically unhealthy obese (MUO). Regardless of obesity status, metabolically unhealthy participants had worse diastolic function compared with their metabolically healthy counterparts (P ≤ 0.0004). Compared with controls, MHO individuals were at higher risk of subclinical LV systolic dysfunction (OR = 3.44, 95% CI = 1.25-9.49, P = 0.02). These results were robust to sensitivity analysis.ConclusionsMHO was substantially associated with worse subclinical systolic function although early diastolic dysfunction seemed to be more accentuated in MUO.

Dataset Information

Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.

Publications

Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.

Similar Datasets

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