TY - JOUR

T1 - Separate and combined associations of obesity and metabolic health with coronary heart disease

T2 - A pan-European case-cohort analysis

AU - Lassale, Camille

AU - Tzoulaki, Ioanna

AU - Moons, Karel G.M.

AU - Sweeting, Michael

AU - Boer, Jolanda

AU - Johnson, Laura

AU - Huerta, José María

AU - Agnoli, Claudia

AU - Freisling, Heinz

AU - Weiderpass, Elisabete

AU - Wennberg, Patrik

AU - Van Der A, Daphne L.

AU - Arriola, Larraitz

AU - Benetou, Vassiliki

AU - Boeing, Heiner

AU - Bonnet, Fabrice

AU - Colorado-Yohar, Sandra M.

AU - Engström, Gunnar

AU - Eriksen, Anne Kirstine

AU - Ferrari, Pietro

AU - Grioni, Sara

AU - Johansson, Matthias

AU - Kaaks, Rudolf

AU - Katsoulis, Michail

AU - Katzke, Verena

AU - Key, Timothy J.

AU - Matullo, Giuseppe

AU - Melander, Olle

AU - Molina-Portillo, Elena

AU - Moreno-Iribas, Concepcion

AU - Norberg, Margareta

AU - Overvad, Kim

AU - Panico, Salvatore

AU - Quiros, J. Ramón

AU - Saieva, Calogero

AU - Skeie, Guri

AU - Steffen, Annika

AU - Stepien, Magdalena

AU - Tjønneland, Anne

AU - Trichopoulou, Antonia

AU - Tumino, Rosario

AU - Van Der Schouw, Yvonne T.

AU - Verschuren, W. M.Monique

AU - Langenberg, Claudia

AU - Di Angelantonio, Emanuele

AU - Riboli, Elio

AU - Wareham, Nicholas J.

AU - Danesh, John

AU - Butterworth, Adam S.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - 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.

AB - 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.

KW - Adiposity

KW - Coronary heart disease

KW - Epidemiology

KW - Metabolic syndrome

KW - Obesity

U2 - 10.1093/eurheartj/ehx448

DO - 10.1093/eurheartj/ehx448

M3 - Journal article

C2 - 29020414

AN - SCOPUS:85044078598

VL - 39

SP - 397

EP - 406

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 5

ER -