Abstract
BackgroundMetabolically healthy obese (MHO) individuals and their association with cardiometabolic diseases have remained controversial. We aimed to explore the risk of incident heart failure (HF) based on the baseline metabolic health and obesity status as well as their transition over 2 years.MethodsThe Korean National Health Insurance Service-National Health Screening Cohort data of 514,886 participants were analyzed. Obesity was defined as BMI ≥25 kg/m2 according to the Korean Centers for Disease Control and Prevention. The metabolic health and obesity status were evaluated at baseline and after two years. Study participants were followed to either the date of newly diagnosed HF or the last follow-up visit, whichever occurred first.ResultsThe MHO group comprised 9.1% of the entire population and presented a better baseline metabolic profile than the metabolically unhealthy non-obese (MUNO) and metabolicavlly unhealthy obese (MUO) groups. During the median 71.3 months of follow-up, HF developed in 5,406 (1.5%) participants. The adjusted hazard ratios [HRs (95% CI)] of HF at baseline compared with the metabolically healthy non-obese (MHNO) group were 1.29 [1.20–1.39], 1.37 [1.22–1.53], and 1.63 [1.50–1.76] for MUNO, MHO, and MUO groups, respectively. With the stable MHNO group as reference, transition into metabolically unhealthy status (MUNO and MUO) increased the risk of HF, regardless of the baseline status. Subjects who were obese at both baseline and follow-up showed an increased risk of HF, regardless of their metabolic health status.ConclusionsMetabolic health and obesity status and their transition can predict the risk of incident HF. Losing metabolic health in baseline non-obese and obese individuals and remaining obese in baseline obese individuals showed a significantly increased risk of incident HF. Maintaining good metabolic health and a lean body may prevent the development of HF.
Highlights
Obesity is a major global health issue, as the prevalence of obesity has constantly increased to a degree that almost one-third of the population worldwide is either overweight or obese [1]
We aimed to investigate the effect of metabolic health and obesity status on the risk of developing heart failure (HF) in a large national population-based cohort
The mean total cholesterol (TC) levels in the metabolically healthy obese (MHO) group were marginally above normal, and the systolic and diastolic blood pressure (BP) levels were significantly higher in the MHO group compared with the metabolically healthy non-obese (MHNO) group
Summary
Obesity is a major global health issue, as the prevalence of obesity has constantly increased to a degree that almost one-third of the population worldwide is either overweight or obese [1]. The subgroup that does not exhibit cardiovascular and metabolic outcomes of obesity is classified as metabolically healthy obese (MHO) [5]. MHO individuals are characterized by normal blood pressure (BP), favorable lipid profiles, and better insulin sensitivity despite their increased adiposity and can be exempted from increased risk of obesity-related disorders [6, 7]; the prognostic value of MHO is debatable and it might depend on the health outcomes being tested [5, 8]. MHO is not a fixed state, as metabolic health is a dynamic concept that can change over time. Alteration of an individual’s metabolic health and obesity status over time should be considered while evaluating the risk of obesity-related disorders [4]. Healthy obese (MHO) individuals and their association with cardiometabolic diseases have remained controversial. We aimed to explore the risk of incident heart failure (HF) based on the baseline metabolic health and obesity status as well as their transition over 2 years
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