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Metabolically healthy obesity and the risk for subclinical atherosclerosis

  • Author Footnotes
    1 These authors contributed equally to this work as co-first authors of this paper.
    Tae Jun Kim
    Footnotes
    1 These authors contributed equally to this work as co-first authors of this paper.
    Affiliations
    Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    1 These authors contributed equally to this work as co-first authors of this paper.
    Hee-Young Shin
    Footnotes
    1 These authors contributed equally to this work as co-first authors of this paper.
    Affiliations
    Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Yoosoo Chang
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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  • Mira Kang
    Affiliations
    Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Jaehwan Jee
    Affiliations
    Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Yoon-Ho Choi
    Affiliations
    Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Hyeon Seon Ahn
    Affiliations
    Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Soo Hyun Ahn
    Affiliations
    Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Hee Jung Son
    Correspondence
    Corresponding author. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
    Affiliations
    Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Seungho Ryu
    Correspondence
    Corresponding author. Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu , Seoul 100-742, Republic of Korea.
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work as co-first authors of this paper.

      Highlights

      • Obesity and metabolic abnormalities are known risk factors for cardiovascular disease.
      • Risk of cardiovascular disease among obese people without metabolic abnormalities remains unclear.
      • Metabolically healthy obese phenotype was associated with an increased risk of incident subclinical carotid atherosclerosis.

      Abstract

      Background and aims

      Although obesity and metabolic abnormalities are known risk factors for cardiovascular disease, the risk of cardiovascular disease among obese individuals without obesity-related metabolic abnormalities, referred to as metabolically healthy obese (MHO), remains unclear. We examined the association between body mass index categories and the development of subclinical carotid atherosclerosis in a cohort of metabolically healthy individuals.

      Methods

      We conducted a cohort study of 6453 men without subclinical carotid atherosclerosis or metabolic abnormalities at baseline, who underwent repeated health check-up examinations that included carotid ultrasound. A metabolically healthy state was defined as having no metabolic syndrome components and a homeostasis model assessment of insulin resistance <2.5. Subclinical carotid atherosclerosis was assessed using ultrasound.

      Results

      During the follow-up period of 34,797.9 person-years, subclinical carotid atherosclerosis developed in 1916 participants. Comparing overweight and obese with normal weight participants, the multivariable adjusted hazard ratios (95% confidence intervals) for incident subclinical carotid atherosclerosis were 1.24 (1.12–1.38) and 1.54 (1.38–1.72), respectively. The association persisted after further adjustment for metabolic variables. This association was also evident in MHO men without abdominal obesity (waist circumference > 90 cm) and it did not differ across any clinically relevant subgroups evaluated.

      Conclusions

      In a large cohort study of strictly defined metabolically healthy participants, the MHO phenotype was associated with an increased risk of incident subclinical carotid atherosclerosis, providing evidence that the MHO phenotype is not protective from cardiovascular risk.

      Keywords

      Abbreviations:

      MHO (metabolically healthy obese), HbA1c (glycated hemoglobin), CIMT (carotid intima-media thickness), HOMA-IR (homeostatic model assessment-insulin resistance)
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      Linked Article

      • Fat or fit: The big oxymoron of (metabolically) healthy obesity
        AtherosclerosisVol. 262
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          Among the major concerns for public health, the prevalence of obesity is raising worldwide with an inexorable pace. In 2014, over 600 million adults worldwide were obese (and more than 1.9 billion overweight) and current projections predict that over 1 billion individuals (reflecting approximately 20% of humankind) will be obese by 2030 [1,2]. Strong epidemiological evidence links obesity with increased morbidity and mortality for several diseases such as cardiovascular diseases (CVD), stroke, cancer, and diabetes, so that current preventive and therapeutic strategies for most of these conditions require management of obesity and body weight [3,4].
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