Healthy Obesity Still Leads to Cardiovascular Events

Even patients with obesity who are deemed metabolically healthy have an increased risk of developing cardiovascular disease-related events compared with normal weight patients, according to a new study presented at the European Congress on Obesity.

Patients with metabolically healthy obesity (MHO) are obese according to body mass index (BMI), but do not have metabolic complications, such as abnormal blood fat levels, poor blood glucose control, diabetes, or high blood pressure.

Whether MHO is linked to an increased rate of cardiovascular disease has been highly contested. The argument is limited by inconsistent definitions of metabolic health, inconsistent control for other factors, and small studies.

In the current study, the authors aim to address the gaps through data from electronic health records for 3.5 million adults included in The Health Improvement Network between 1995 and 2015. At baseline, no patients were diagnosed with cardiovascular disease.

The patients were grouped by BMI and the status of diabetes, hypertension, and hyperlipidemia. The status of the metabolic abnormalities was added together to create a score of 0 to 3. Patients with MHO were classified as a score of 0, as they had no metabolic abnormalities.

The authors assessed whether healthy patients or those with MHO were at risk of developing coronary heart disease (CHD), cerebrovascular disease (transient ischemic attack or stroke), heart failure, and peripheral vascular disease (PVD).

Compared with normal weight patients with no metabolic abnormalities, patients with MHO had a 50% increased risk of developing CHD, according to the study. Additionally, patients with MHO had a 7% increased risk of cerebrovascular disease and a doubled risk of developing heart failure.

After accounting for demographics and smoking status, patients with MHO had a 9% lower risk of developing PVD than previously found. In another analysis that excluded smokers, patients with MHO had an 11% lower risk of PVD compared with healthy patients, according to the study.

"This is the largest prospective study of the association between metabolically health obesity and cardiovascular disease events. Metabolically healthy obese individuals are at higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight metabolically healthy individuals,” Dr Caleyachetty said. “The priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities."

The authors also found that patients with obesity had an increased risk of cardiovascular events, with prevalence increasing along with the number of metabolic abnormalities.

Patients with obesity and 3 metabolic abnormalities were observed to have a 2.6 times increased risk of CHD, a 3.8 times increased risk of heart failure, and a 2.2 times increased risk of PVD compared with healthy patients, according to the study. These patients were also 58% more likely to develop cerebrovascular disease than normal weight patients with no abnormalities.

While patients with MHO are considered healthy in metabolic terms, physicians should encourage them to lose weight to prevent cardiovascular disease and related events.

"At the population-level, so-called metabolically healthy obesity is not a harmless condition and perhaps it is better not to use this term to describe an obese person, regardless of how many metabolic complications they have,” Dr Caleyachetty concluded.