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High Burden of Subclinical and Cardiovascular Disease Risk in Adults with Metabolically Healthy Obesity: The Atherosclerosis Risk in Communities (ARIC) Study

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posted on 05.05.2021, 18:28 by Yvonne Commodore-Mensah, Mariana Lazo, Olive Tang, Justin Echouffo-Tcheugui, Chiadi E. Ndumele, Vijay Nambi, Dan Wang, Christie Ballantyne, Elizabeth Selvin
OBJECTIVE: It is controversial whether adults who are obese, but "metabolically healthy" have cardiovascular disease (CVD) risk comparable to normal weight adults. High-sensitivity cardiac troponin T(hs-cTnT), a biomarker of myocardial damage, is useful in characterizing subclinical CVD. We categorized obesity phenotypes and studied their associations with subclinical and clinical CVD and CVD subtypes, including heart failure (HF).

RESEARCH DESIGN AND METHODS: We conducted cross-sectional and prospective analyses of 9,477 adults in the Atherosclerosis Risk in Communities (ARIC) Study. We used the Adult Treatment Panel III criteria and body mass index (BMI) to define obesity phenotypes as metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOv), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOv), and metabolically unhealthy obese (MUO).

RESULTS: At baseline (1990-1992), mean age was 56 years, 56% were female, 23% Black, 25% detectable hs-cTnT(≥ 6 ng/L). Over a median 17 years of follow-up, there were 2,603 clinical CVD events. The MHO (HR 1.38, 95%CI:1.15-1.67), MUNW (HR 1.51, 95%CI:1.30-1.76), MUOv (HR 1.60, 95%CI:1.41-1.82) and MUO (HR 2.14, 95%CI: 1.88-2.44) phenotypes had higher CVD risks than the MHNW. Detectable hs-cTnT(≥ 6 ng/L) was associated with higher CVD risk, even among MHNW adults. MHO adults had higher HF risk (HR 1.65, 95%CI:1.30-2.09) than the MHNW.

CONCLUSIONS: The MHO phenotype was associated with excess burden of clinical CVD, primarily driven by an excess risk of HF. Hs-cTnT was useful in stratifying CVD risk across all obesity phenotypes, even among obese persons who appear otherwise metabolically healthy.


The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). Support was received from the National Institute of Health (5KL2TR001077-05 to YCM), National Institute of Diabetes and Digestive and Kidney Diseases (F30 DK120160 to OT and K24 HL152440 and R01 DK089174 to ES) and from the National Heart, Lung, and Blood Institute (R01 HL134320 to CMB and ES) of the National Institutes of Health. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of NIH.