Mirzaei Bita, Abdi Hengameh, Serahati Sara, Barzin Maryam, Niroomand Mahtab, Azizi Fereidoun, Hosseinpanah Farhad
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
Atherosclerosis. 2017 Mar;258:65-71. doi: 10.1016/j.atherosclerosis.2017.02.002. Epub 2017 Feb 3.
Considering the inconsistent data available on cardiovascular (CV) risk of different obesity phenotypes, the aim of this study was to investigate the development of cardiovascular disease (CVD) in different obesity phenotypes over a median follow-up of 12 years.
In this large population-based cohort, 7842 participants (44.8% men), aged ≥ 30 years, were enrolled. Participants were divided into six phenotypes based on body mass index and metabolic status. Metabolic health was defined based on two definitions: 1) having ≤1 component of metabolic syndrome using the Joint Interim Statement (JIS) criteria and 2) homeostasis model assessment-insulin resistance (HOMA-IR) < 2.6 mole × μU/L. Multivariate adjusted hazard ratios (HRs) were calculated for cardiovascular events.
A total of 712 new CVD events occurred. CV risk increased in all metabolically unhealthy phenotypes. Multivariable adjusted HRs for CVD events in metabolically healthy overweight (MHOW) and metabolically healthy obese (MHO) participants were 1.22 (0.73-2.04) and 1.74 (0.68-4.44), respectively. CV risk increased in all obesity phenotypes based on insulin resistance except the insulin resistance-normal weight group. However, this increased risk disappeared after further adjustment for metabolic risk factors.
Our findings showed that CV risk did not increase in MHOW and MHO phenotypes over a 12-year follow-up. However, all metabolically unhealthy phenotypes were associated with increased incident CVD. Further studies with longer follow-up are needed to confirm the benign nature of MHOW/MHO phenotypes.
鉴于不同肥胖表型的心血管（CV）风险数据存在不一致性，本研究旨在对不同肥胖表型的人群进行为期12年的中位随访，以调查心血管疾病（CVD）的发病情况。
在这个基于人群的大型队列研究中，纳入了7842名年龄≥30岁的参与者（44.8%为男性）。参与者根据体重指数和代谢状态被分为六种表型。代谢健康基于两种定义：1）使用联合临时声明（JIS）标准，代谢综合征的组成成分≤1项；2）稳态模型评估-胰岛素抵抗（HOMA-IR）<2.6摩尔×微单位/升。计算心血管事件的多变量调整风险比（HRs）。
共发生712例新发CVD事件。所有代谢不健康的表型的心血管风险均增加。代谢健康超重（MHOW）和代谢健康肥胖（MHO）参与者发生CVD事件的多变量调整HRs分别为1.22（0.73-2.04）和1.74（0.68-4.44）。基于胰岛素抵抗的所有肥胖表型的心血管风险均增加，但胰岛素抵抗-正常体重组除外。然而，在进一步调整代谢风险因素后，这种增加的风险消失了。
我们的研究结果表明，在12年的随访中，MHOW和MHO表型的心血管风险并未增加。然而，所有代谢不健康的表型均与CVD发病率增加相关。需要进行更长时间随访的进一步研究来证实MHOW/MHO表型的良性性质。
