Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; University of Potsdam, Institute of Nutritional Sciences, Nuthetal, Germany.
Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
Lancet Diabetes Endocrinol. 2018 Sep;6(9):714-724. doi: 10.1016/S2213-8587(18)30137-2. Epub 2018 May 31.
Cardiovascular disease risk among individuals across different categories of BMI might depend on their metabolic health. It remains unclear to what extent metabolic health status changes over time and whether this affects cardiovascular disease risk. In this study, we aimed to examine the association between metabolic health and its change over time and cardiovascular disease risk across BMI categories.
Between June and December, 1976, 121 701 female nurses were recruited to the Nurses' Health Study (NHS) of whom 103 298 returned a questionnaire in 1980 used as baseline in this study. After excluding women with a history of cardiovascular disease or cancer, with missing body weight and with underweight. 90 257 women were followed-up from 1980 to 2010 for incident cardiovascular disease. Participants were cross-classified by BMI categories, metabolic health (defined by absence of diabetes, hypertension and hypercholesterolaemia), and change in metabolic health status during follow-up. The cardiovascular component of the NHS is registered with ClinicalTrials.gov, number NCT00005152.
During 2 127 391 person-years of follow-up with a median follow-up of 24 years, we documented 6306 cases of cardiovascular disease including 3304 myocardial infarction cases and 3080 strokes. Cardiovascular disease risk of women with metabolically healthy obesity was increased compared with women with metabolically healthy normal weight (HR 1·39, 95% CI 1·15-1·68), but risk was considerably higher in women with metabolically unhealthy normal weight (2·43, 2·19-2·68), overweight (2·61, 2·36-2·89) and obesity (3·15, 2·83-3·50). The majority of metabolically healthy women converted to unhealthy phenotypes (2555 [84%] of 3027 women with obesity, 22 215 [68%] of 32 882 women with normal-weight after 20 years). Women who maintained metabolically healthy obesity during follow-up were still at a higher cardiovascular disease risk compared with women with stable healthy normal weight (HR 1·57, 1·03-2·38), yet this risk was lower than for initially metabolically healthy women who converted to an unhealthy phenotype (normal-weight 1·90, 1·66-2·17 vs obesity 2·74, 2·30-3·27). Particularly incident diabetes and hypertension increased the risk among women with initial metabolic health.
Even when metabolic health is maintained during long periods of time, obesity remains a risk factor for cardiovascular disease. However, risks are highest for metabolically unhealthy women across all BMI categories. A large proportion of metabolically healthy women converted to an unhealthy phenotype over time across all BMI categories, which is associated with an increased cardiovascular disease risk.
US National Institutes of Health, German Federal Ministry of Education and Research.
不同 BMI 类别的个体的心血管疾病风险可能取决于其代谢健康状况。代谢健康状况随时间的变化程度以及这是否影响心血管疾病风险仍不清楚。在这项研究中，我们旨在研究代谢健康及其随时间的变化与 BMI 类别之间的心血管疾病风险之间的关联。
1976 年 6 月至 12 月，招募了 121701 名女护士参加护士健康研究（NHS），其中 103298 名护士在 1980 年返回了一份问卷，作为本研究的基线。排除了有心血管疾病或癌症病史、体重缺失和体重不足的妇女。在 1980 年至 2010 年期间，90257 名女性因心血管疾病发病而接受随访。参与者按 BMI 类别、代谢健康状况（定义为无糖尿病、高血压和高胆固醇血症）和随访期间代谢健康状况的变化进行交叉分类。NHS 的心血管部分在 ClinicalTrials.gov 注册，编号为 NCT00005152。
在 2127391 人年的中位随访时间为 24 年的随访期间，我们记录了 6306 例心血管疾病，包括 3304 例心肌梗死和 3080 例中风。与代谢健康的正常体重女性相比，肥胖且代谢健康的女性的心血管疾病风险增加（HR 1.39，95%CI 1.15-1.68），但与代谢不健康的正常体重女性（2.43，2.19-2.68）、超重（2.61，2.36-2.89）和肥胖（3.15，2.83-3.50）相比，风险更高。大多数代谢健康的女性转变为不健康的表型（3027 名肥胖女性中有 2555 名[84%]，32882 名正常体重女性中有 22215 名[68%]在 20 年后）。与稳定的健康正常体重女性相比，在随访期间保持代谢健康肥胖的女性仍处于更高的心血管疾病风险（HR 1.57，1.03-2.38），但这一风险低于最初具有代谢健康且转变为不健康表型的女性（正常体重 1.90，1.66-2.17 与肥胖 2.74，2.30-3.27）。最初的代谢健康女性中，特别是新发糖尿病和高血压会增加女性的风险。
即使在长时间内保持代谢健康，肥胖仍然是心血管疾病的一个危险因素。然而，在所有 BMI 类别中，代谢不健康的女性风险最高。随着时间的推移，大量代谢健康的女性在所有 BMI 类别中转变为不健康的表型，这与心血管疾病风险增加有关。
美国国立卫生研究院，德国联邦教育和研究部。
