Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
Front Endocrinol (Lausanne). 2023 May 26;14:1140472. doi: 10.3389/fendo.2023.1140472. eCollection 2023.
Obesity has become a serious public health problem and brings a heavy burden of cardiovascular disease. Metabolically healthy obesity (MHO) is defined as individuals with obesity with no or only minor metabolic complications. Whether individuals with MHO have a lower cardiovascular risk remains controversial. In this study, a new criterion was used to define MHO and assess its predictive value for cardiovascular events and death. At the same time, the new criterion and the traditional criterion are compared to analyze the differences between different diagnostic criteria.
A prospective cohort was established in northeast rural China from 2012 to 2013. Follow-up was conducted in 2015 and 2018 to investigate the incidence of cardiovascular events and survival. Subjects were grouped according to the metabolic health and obesity status. Kaplan-Meier curves were drawn to describe the cumulative risk of endpoint events in the four groups. Cox regression analysis model was constructed to evaluate the risk of endpoint events. Analysis of variance and analyses were used to calculate and compare differences in metabolic markers between MHO subjects diagnosed by novel and traditional criteria.
A total of 9345 participants 35 years of age or older without a history of cardiovascular disease were included in this study. After a median follow-up of 4.66 years, the data showed that participants in the MHO group had no significant increase in the risk of composite cardiovascular events and stroke, but had a 162% increase in the risk of coronary heart disease (HR: 2.62; 95%CI: 1.21-5.67). However, when using conventional criteria for metabolic health, mMHO group had a 52% increase in combined CVD risk (HR: 1.52; 95%CI: 1.14-2.03). By comparing the differences of metabolic indicators between MHO subjects diagnosed by the two criteria, MHO subjects diagnosed by the new criterion had higher WC, WHR, TG, FPG, and lower HDL-C levels except for lower blood pressure, showing more exposure to cardiovascular risk factors.
The risk of combined CVD and stroke was not increased in MHO subjects. The new metabolic health criterion is superior to the traditional criterion and can effectively identify individuals with obesity with a lower risk of combined CVD. Blood pressure levels may be responsible for the inconsistent risk of combined CVD in MHO subjects diagnosed with both criteria.
肥胖已成为严重的公共卫生问题，给心血管疾病带来了沉重负担。代谢健康型肥胖（MHO）被定义为肥胖但无或仅有轻微代谢并发症的个体。代谢健康型肥胖者的心血管风险是否较低仍存在争议。本研究采用新的标准定义 MHO，并评估其对心血管事件和死亡的预测价值。同时，比较新的标准和传统标准，分析不同诊断标准之间的差异。
2012 年至 2013 年在中国东北地区建立了前瞻性队列研究。2015 年和 2018 年进行了随访，以调查心血管事件和生存的发生率。根据代谢健康和肥胖状况对受试者进行分组。绘制 Kaplan-Meier 曲线描述四组终点事件的累积风险。构建 Cox 回归分析模型评估终点事件的风险。方差分析和 t 检验用于计算和比较新型和传统标准诊断的 MHO 受试者代谢标志物之间的差异。
本研究共纳入 9345 名年龄 35 岁或以上且无心血管疾病史的参与者。中位随访 4.66 年后的数据显示，MHO 组复合心血管事件和卒中风险无显著增加，但冠心病风险增加 162%（HR：2.62；95%CI：1.21-5.67）。然而，当使用代谢健康的传统标准时，mMHO 组的复合 CVD 风险增加 52%（HR：1.52；95%CI：1.14-2.03）。通过比较两种标准诊断的 MHO 受试者代谢指标的差异，新型标准诊断的 MHO 受试者的 WC、WHR、TG、FPG 更高，HDL-C 水平更低，除血压较低外，表明更多地暴露于心血管危险因素。
MHO 受试者的复合 CVD 和卒中风险没有增加。新的代谢健康标准优于传统标准，可有效识别肥胖但 CVD 风险较低的个体。血压水平可能是两种标准诊断的 MHO 受试者的复合 CVD 风险不一致的原因。
