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Cardiovascular risk in different obesity phenotypes over a decade follow-up: Tehran Lipid and Glucose Study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Bita Mirzaei
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Hengameh Abdi
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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  • Sara Serahati
    Affiliations
    Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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  • Maryam Barzin
    Affiliations
    Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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  • Mahtab Niroomand
    Affiliations
    Division of Endocrinology, Department of Internal Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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  • Fereidoun Azizi
    Affiliations
    Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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  • Farhad Hosseinpanah
    Correspondence
    Corresponding author. Obesity Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Science, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran.
    Affiliations
    Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • Data regarding cardiovascular risk of different obesity phenotypes is inconsistent.
      • 7842 individuals, aged ≥30 years, were investigated over 12 years of follow-up.
      • Cardiovascular risk increased in all metabolically unhealthy phenotypes.
      • Cardiovascular risk did not increase in metabolically healthy overweight (MHOW) and obese (MHO) individuals.
      • Further studies with longer follow-up are needed to confirm the benign nature of MHOW/MHO phenotypes.

      Abstract

      Background and aims

      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.

      Methods

      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/L2. Multivariate adjusted hazard ratios (HRs) were calculated for cardiovascular events.

      Results

      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.

      Conclusions

      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.
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