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Combinations of BMI and metabolic syndrome and the risk of myocardial infarction, stroke, and heart failure

Lind, Lars ; Risérus, Ulf ; Elmståhl, Sölve LU ; Ärnlöv, Johan ; Michaëlsson, Karl and Titova, Olga E. (2025) In Nutrition, Metabolism and Cardiovascular Diseases 35(9).
Abstract

Background and aims: The relationship between uncommon phenotypes, such as metabolically healthy obesity and normal weight with metabolic syndrome (MetS), and cardiovascular disease (CVD) risk, remains unclear. We investigated how different combinations of body mass index (BMI) and MetS are associated with overall and specific CVDs and how the number of MetS components influences CVD risk in individuals with obesity. Methods and results: We performed separate analyses and a meta-analysis of 36,233 individuals from four Swedish cohorts to assess the risk of incident CVDs across BMI/MetS combinations (normal-weight, overweight or obese/MetS yes or no). Participants were followed for CVDs and death through linkage to the Swedish National... (More)

Background and aims: The relationship between uncommon phenotypes, such as metabolically healthy obesity and normal weight with metabolic syndrome (MetS), and cardiovascular disease (CVD) risk, remains unclear. We investigated how different combinations of body mass index (BMI) and MetS are associated with overall and specific CVDs and how the number of MetS components influences CVD risk in individuals with obesity. Methods and results: We performed separate analyses and a meta-analysis of 36,233 individuals from four Swedish cohorts to assess the risk of incident CVDs across BMI/MetS combinations (normal-weight, overweight or obese/MetS yes or no). Participants were followed for CVDs and death through linkage to the Swedish National Registers. Compared to normal weight without MetS, overweight and obesity without MetS had most pronounced association with the risk of heart failure [multivariable hazard ratios, HR (95 % CI) = 1.37 (1.16–1.63) and 1.85 (1.37–2.48), respectively, p < 0.001]. In obese individuals, the risk of incident CVD (composite endpoint) increased with an increasing number of MetS components, but this relationship was not statistically significant in obese participants without additional MetS components, likely due to the small at-risk group. Normal-weight individuals with MetS had an increased risk of myocardial infarction [HR (95 % CI) 2.0 (1.51–2.64)], p < 0.001, and stroke [HR (95 % CI) 1.63 (1.17–2.28), p = 0.004]. Conclusions: Overweight and obesity without MetS showed a greater impact on the risk of heart failure, whereas normal-weight individuals with MetS had a higher risk of myocardial infarction and stroke. In obese individuals, CVD risk increased as the number of MetS components increased.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
BMI, Cohort, Heart failure, Metabolic syndrome, Myocardial infarction, Stroke
in
Nutrition, Metabolism and Cardiovascular Diseases
volume
35
issue
9
article number
104102
publisher
Elsevier
external identifiers
  • scopus:105005864805
  • pmid:40414765
ISSN
0939-4753
DOI
10.1016/j.numecd.2025.104102
language
English
LU publication?
yes
id
84cde784-fee8-4507-b7af-700fcf408df7
date added to LUP
2025-09-26 11:41:18
date last changed
2025-10-14 13:30:23
@article{84cde784-fee8-4507-b7af-700fcf408df7,
  abstract     = {{<p>Background and aims: The relationship between uncommon phenotypes, such as metabolically healthy obesity and normal weight with metabolic syndrome (MetS), and cardiovascular disease (CVD) risk, remains unclear. We investigated how different combinations of body mass index (BMI) and MetS are associated with overall and specific CVDs and how the number of MetS components influences CVD risk in individuals with obesity. Methods and results: We performed separate analyses and a meta-analysis of 36,233 individuals from four Swedish cohorts to assess the risk of incident CVDs across BMI/MetS combinations (normal-weight, overweight or obese/MetS yes or no). Participants were followed for CVDs and death through linkage to the Swedish National Registers. Compared to normal weight without MetS, overweight and obesity without MetS had most pronounced association with the risk of heart failure [multivariable hazard ratios, HR (95 % CI) = 1.37 (1.16–1.63) and 1.85 (1.37–2.48), respectively, p &lt; 0.001]. In obese individuals, the risk of incident CVD (composite endpoint) increased with an increasing number of MetS components, but this relationship was not statistically significant in obese participants without additional MetS components, likely due to the small at-risk group. Normal-weight individuals with MetS had an increased risk of myocardial infarction [HR (95 % CI) 2.0 (1.51–2.64)], p &lt; 0.001, and stroke [HR (95 % CI) 1.63 (1.17–2.28), p = 0.004]. Conclusions: Overweight and obesity without MetS showed a greater impact on the risk of heart failure, whereas normal-weight individuals with MetS had a higher risk of myocardial infarction and stroke. In obese individuals, CVD risk increased as the number of MetS components increased.</p>}},
  author       = {{Lind, Lars and Risérus, Ulf and Elmståhl, Sölve and Ärnlöv, Johan and Michaëlsson, Karl and Titova, Olga E.}},
  issn         = {{0939-4753}},
  keywords     = {{BMI; Cohort; Heart failure; Metabolic syndrome; Myocardial infarction; Stroke}},
  language     = {{eng}},
  number       = {{9}},
  publisher    = {{Elsevier}},
  series       = {{Nutrition, Metabolism and Cardiovascular Diseases}},
  title        = {{Combinations of BMI and metabolic syndrome and the risk of myocardial infarction, stroke, and heart failure}},
  url          = {{http://dx.doi.org/10.1016/j.numecd.2025.104102}},
  doi          = {{10.1016/j.numecd.2025.104102}},
  volume       = {{35}},
  year         = {{2025}},
}