Ryu S, Chang Y, Cho J, Zhang Y, Rampal S, Zhao D, Choi Y, Ahn J, Cainzos-Achirica M, Pastor-Barriuso R, Lima JA, Shin H, Guallar E. Metabolically healthy obesity and the risk of incident ischemic heart disease and stroke – the Kangbuk Samsung health study. Poster presented at the American Heart Association – American Stroke Association EPI-Lifestyle 2015; March 2015. Baltimore, MD. [abstract] Circulation. 2015 Mar 10; 131(Suppl 1).

OBJECTIVE: The risk of cardiovascular disease (CVD) among obese individuals without obesity-related metabolic abnormalities, usually referred to as metabolically healthy obesity (MHO), is controversial. Furthermore, the association between MHO and the risk of stroke has not been evaluated in prospective studies.

HYPOTHESIS: We evaluated the hypothesis that MHO is associated with an increased risk of incident coronary heart disease (CHD) and stroke compared to metabolically healthy normal weight subjects.

METHODS: We performed a cohort study in 98,414 metabolically healthy adults without CVD at baseline who underwent a health checkup exam during 2008 - 2011 and were followed-up through December 31, 2012 (average follow-up of 3.0 years). Being metabolic healthy was defined as not having any of the components of the metabolic syndrome and having a homeostasis model assessment of insulin resistance (HOMA-IR) less than 2.5. Incident hospitalizations for CHD events and strokes were ascertained through data linkage with the Korean Health Insurance Review and Assessment Service (HIRA) database.

RESULTS: During follow-up, 284 participants developed CHD and 223 subjects developed stroke. After adjusting for age, sex, center, year of screening exam, smoking, alcohol intake, physical activity, family history of CVD, and education, the hazard ratios (95 % confidence intervals) for CHD and stroke comparing MHO to normal weight participants were 1.67 (1.25 - 2.25) and 1.46 (1.02 - 2.10), respectively. These associations did not differ by clinically relevant subgroups, although the association between MHO and the risk of incident stroke was stronger in younger participants (P for interaction 0.02).

CONCLUSIONS: Participants with MHO had a higher incidence of CHD and of stroke compared to metabolically healthy normal weight participants, supporting that MHO is not a harmless condition. The findings of this study suggest that prevention strategies are needed in all obese individuals, including those without obesity-related metabolic abnormalities, to reduce the risk of CVD.

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