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Zhao M, Zhang N, Wang M, Yao S, Wang C, Yun C, Zhang S, Sun Y, Hou Z, Chen S, Wu S, Li Y, Xue H. Transitions in Metabolic Health and Onset Age of Cardiovascular Diseases. Am J Prev Med 2023; 65:1059-1068. [PMID: 37295660 DOI: 10.1016/j.amepre.2023.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The cardiometabolic risk associated with metabolically healthy obesity remains the subject of debate. It is unclear whether changes in metabolically healthy obesity status affect premature cardiovascular disease (CVD) risk. Authors aimed to investigate the association of metabolically healthy obesity and its transition over time with incident CVD by age at onset. METHODS In a community-based, prospective cohort study, 54,441 adults without CVD in or before 2010 were followed for incident CVD until 2020. This sample was analyzed in 2022. Four age groups were examined (<55, 55-65, 65-75, and ≥75 years) for CVD onset. In each age group, participants were cross-classified by BMI categories and metabolic health. The Cox proportional hazards model with age as the underlying time scale was used to examine the associations of metabolic health status and its transition with CVD across BMI categories. RESULTS During a median follow-up of 9.59 years, 3,038 participants developed CVD. Individuals with metabolically unhealthy obesity at baseline had the highest hazard ratio for CVD onset at any age, ranging from 2.68 (95% CI=2.02, 3.55) for CVD onset in those aged <55 years to 1.55 (95% CI=1.09, 2.10) for CVD onset in those aged ≥75 years. Individuals who had metabolically healthy obesity at baseline or even remained metabolically healthy during 2006-2010 were still at increased risk of premature CVD, and the association attenuated with increasing age of CVD onset. CONCLUSIONS The metabolically healthy obesity phenotype is dynamic and its transition to a metabolically unhealthy phenotype or even stable metabolically healthy obesity is associated with an increased risk of CVD. The associations were more evident for CVD onset at younger ages.
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Affiliation(s)
- Maoxiang Zhao
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Nan Zhang
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Miao Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Siyu Yao
- Department of Cardiology, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chi Wang
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Cuijuan Yun
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Sijin Zhang
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Yizhen Sun
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Ziwei Hou
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Tangshan, China
| | - Yang Li
- Department of Cardiology, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hao Xue
- Department of Cardiology, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Wang X, Dong J, Du Z, Jiang J, Hu Y, Qin L, Hao Y. Risk of Heart Failure between Different Metabolic States of Health and Weight: A Meta-Analysis of Cohort Studies. Nutrients 2022; 14:nu14245223. [PMID: 36558382 PMCID: PMC9785251 DOI: 10.3390/nu14245223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
We conducted a systematic review of cohort studies comparing the risk of heart failure in people with differing metabolic health and obesity statuses. We searched three electronic databases (PubMed, Web of Science, Scopus), where the studies of the relationships of metabolic health and obesity statuses with heart failure were included. Fixed-effects or random-effects models were used to estimate the summary relative risks [RRs]. Ten cohort studies were selected. Compared with individuals with normal metabolic health and body mass, the pooled RRs (95% confidence intervals) for heart failure were 1.23 (1.17, 1.29) for metabolic healthy overweight individuals, 1.52 (1.40, 1.64) for metabolic healthy individuals with obesity, 1.56 (1.30, 1.87) for metabolically unhealthy normal-weight individuals, 1.75 (1.55, 1.98) for metabolically unhealthy overweight individuals, and 2.28 (1.96, 2.66) for metabolic unhealthy individuals with obesity. A sensitivity analysis suggested that no single study had a substantial effect on the results. The Egger's and Begg's tests showed no evidence of publication bias. People with overweight or obesity were at a higher risk of heart failure, even if metabolically healthy. In addition, compared with metabolically healthy normal-weight individuals; metabolically unhealthy normal-weight individuals, and those with overweight or and obesity, were at higher risk of heart failure.
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Affiliation(s)
- Xiaowen Wang
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing 100191, China
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 5650871, Japan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Jiayi Dong
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 5650871, Japan
- Correspondence: (J.D.); (Y.H.); Tel.: +81-06-6879-3911 (J.D.); +86-10-8280-5061 (Y.H.)
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510275, China
| | - Jie Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Liqiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou 215000, China
| | - Yuantao Hao
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing 100191, China
- Correspondence: (J.D.); (Y.H.); Tel.: +81-06-6879-3911 (J.D.); +86-10-8280-5061 (Y.H.)
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Lind L, Markstad H, Ahlström H, Angerås O, Brandberg J, Brunström M, Engström G, Engvall JE, Eriksson MJ, Eriksson M, Gottsäter A, Hagström E, Krachler B, Lampa E, Mannila M, Nilsson PM, Nyström FH, Persson A, Redfors B, Sandström A, Themudo R, Völz S, Ärnlöv J, Östgren CJ, Bergström G. Obesity is associated with coronary artery stenosis independently of metabolic risk factors: The population-based SCAPIS study. Atherosclerosis 2022; 362:1-10. [PMID: 36356325 DOI: 10.1016/j.atherosclerosis.2022.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Previous studies reported divergent results on whether metabolically healthy obesity is associated with increased coronary artery calcium and carotid plaques. We investigated this in a cross-sectional fashion in a large, well-defined, middle-aged population using coronary CT angiography (CCTA) and carotid ultrasound. METHODS In the SCAPIS study (50-65 years, 51% female), CCTA and carotid artery ultrasound were performed in 23,674 individuals without clinical atherosclerotic disease. These subjects were divided into six groups according to BMI (normal weight, overweight, obese) and the presence of metabolic syndrome (MetS) according to the NCEP consensus criteria. RESULTS The severity of coronary artery stenosis was increased in individuals with obesity without MetS compared to normal-weight individuals without MetS (OR 1.47, 95%CI 1.34-1.62; p < 0.0001), even after adjusting for non-HDL-cholesterol and several lifestyle factors. Such difference was not observed for the presence of carotid artery plaques (OR 0.94, 95%CI 0.87-1.02; p = 0.11). Obese or overweight individuals without any MetS criteria (except the waist criterion) showed significantly more pronounced stenosis in the coronary arteries as compared to the normal-weight individuals, while one criterion was needed to show increased plaque prevalence in the carotid arteries. High blood pressure was the most important single criterion for increased atherosclerosis in this respect. CONCLUSIONS Individuals with obesity without MetS showed increased severity of coronary artery stenosis, but no increased occurrence of carotid artery plaques compared to normal-weight individuals without MetS, further emphasizing that obesity is not a benign condition even in the absence of MetS.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
| | - Hanna Markstad
- Center for Medical Imaging and Physiology, Skåne University Hospital Lund University, Lund, Sweden; Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anders Gottsäter
- Department of Medicine, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Benno Krachler
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Maria Mannila
- Heart and Vascular Theme, Department of Cardiology and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anette Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Raquel Themudo
- Radiology Department, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Carl Johan Östgren
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Prolonged or Transition to Metabolically Unhealthy Status, Regardless of Obesity Status, Is Associated with Higher Risk of Cardiovascular Disease Incidence and Mortality in Koreans. Nutrients 2022; 14:nu14081644. [PMID: 35458208 PMCID: PMC9028697 DOI: 10.3390/nu14081644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Abstract
The risk of chronic disease and mortality may differ by metabolic health and obesity status and its transition. We investigated the risk of cardiovascular disease (CVD) and cancer incidence and mortality according to metabolic health and obesity status and their transition using the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) and the Ansan-Ansung (ASAS) cohort of the Korean Genome and Epidemiology Study. Participants that agreed to mortality linkage (n = 28,468 in KNHANES and n = 7530 adults in ASAS) were analyzed (mean follow-up: 8.2 and 17.4 years, respectively). Adults with no metabolic risk factors and BMI <25 or ≥25 kg/m2 were categorized as metabolically healthy non-obese (MHN) or metabolically healthy obese (MHO), respectively. Metabolically unhealthy non-obese (MUN) and metabolically unhealthy obese (MUO) adults had ≥1 metabolic risk factor and a BMI < or ≥25 kg/m2, respectively. In KNHANES participants, MUN, and MUO had higher risks for cardiovascular mortality, but not cancer mortality, compared with MHN adults. MHO had 47% and 35% lower risks of cancer mortality and all-cause mortality, respectively, compared to MHN. Similar results were observed in the ASAS participants. Compared to those persistently MHN, the risk of CVD was greater when continuously MUN or MUO. Transitioning from a metabolically healthy state to MUO also increased the risk of CVD. Few associations were found for cancer incidence. Using a nationally representative cohort and an 18-year follow-up cohort, we observed that the risk of CVD incidence and mortality and all-cause mortality, but not cancer incidence or mortality, increases with a continuous or a transition to an unhealthy metabolic status in Koreans.
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