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Separate and combined associations of obesity and metabolic health with coronary heart disease : A pan-European case-cohort analysis

Lassale, Camille; Tzoulaki, Ioanna; Moons, Karel G.M.; Sweeting, Michael; Boer, Jolanda; Johnson, Laura; Huerta, José María; Agnoli, Claudia; Freisling, Heinz and Weiderpass, Elisabete, et al. (2018) In European Heart Journal 39(5). p.397-406
Abstract

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk We tested this hypothesis in a large pan-European prospective study. Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol,... (More)

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk We tested this hypothesis in a large pan-European prospective study. Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.

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Contribution to journal
publication status
published
subject
keywords
Adiposity, Coronary heart disease, Epidemiology, Metabolic syndrome, Obesity
in
European Heart Journal
volume
39
issue
5
pages
10 pages
publisher
Oxford University Press
external identifiers
  • scopus:85044078598
ISSN
0195-668X
DOI
10.1093/eurheartj/ehx448
language
English
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yes
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9195576b-3dba-4781-99b1-e578d7bdbf16
date added to LUP
2018-04-09 12:03:32
date last changed
2018-11-21 21:39:08
@article{9195576b-3dba-4781-99b1-e578d7bdbf16,
  abstract     = {<p>Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk We tested this hypothesis in a large pan-European prospective study. Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.</p>},
  author       = {Lassale, Camille and Tzoulaki, Ioanna and Moons, Karel G.M. and Sweeting, Michael and Boer, Jolanda and Johnson, Laura and Huerta, José María and Agnoli, Claudia and Freisling, Heinz and Weiderpass, Elisabete and Wennberg, Patrik and Van Der A, Daphne L. and Arriola, Larraitz and Benetou, Vassiliki and Boeing, Heiner and Bonnet, Fabrice and Colorado-Yohar, Sandra M. and Engström, Gunnar and Eriksen, Anne K. and Ferrari, Pietro and Grioni, Sara and Johansson, Matthias and Kaaks, Rudolf and Katsoulis, Michail and Katzke, Verena and Key, Timothy J. and Matullo, Giuseppe and Melander, Olle and Molina-Portillo, Elena and Moreno-Iribas, Concepcion and Norberg, Margareta and Overvad, Kim and Panico, Salvatore and Quiros, J. Ramón and Saieva, Calogero and Skeie, Guri and Steffen, Annika and Stepien, Magdalena and Tjønneland, Anne and Trichopoulou, Antonia and Tumino, Rosario and Van Der Schouw, Yvonne T. and Verschuren, W. M.Monique and Langenberg, Claudia and Di Angelantonio, Emanuele and Riboli, Elio and Wareham, Nicholas J. and Danesh, John and Butterworth, Adam S.},
  issn         = {0195-668X},
  keyword      = {Adiposity,Coronary heart disease,Epidemiology,Metabolic syndrome,Obesity},
  language     = {eng},
  month        = {02},
  number       = {5},
  pages        = {397--406},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Separate and combined associations of obesity and metabolic health with coronary heart disease : A pan-European case-cohort analysis},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehx448},
  volume       = {39},
  year         = {2018},
}