Abstract
BackgroundWhether being metabolically healthy obese (MHO)—defined by the presence of obesity in the absence of metabolic syndrome—is associated with subsequent cardiovascular disease (CVD) remains unclear and may depend on the participants’ age. We examined the association of being MHO with CVD risk in the elderly.Methods and FindingsThis study included 5,314 individuals (mean age 68 years) from the prospective population-based Rotterdam Study. We categorized our population in groups according to body mass index (BMI) and presence and absence of metabolic syndrome, and estimated the hazard ratio (HR) and 95% confidence interval (95%CI) for every group by using Cox proportional hazard models. Among 1048 (19.7%) obese individuals we identified 260 (24.8%) MHO subjects. Over 14 years of follow-up there were 861 incident CVD cases. In the multivariable adjusted analysis, we did not observe an increased CVD risk in MHO individuals (HR 1.07, 95%CI 0.75–1.53), compared to normal weight individuals without metabolic syndrome. CVD risk was increased by the presence of metabolic syndrome in normal weight (HR 1.35, 95%CI 1.02–1.80), overweight (HR 1.32, 95%CI 1.09–1.60) and obese (HR 1.33, 95%CI 1.07–1.66) individuals, compared to those with normal weight without metabolic syndrome. In a mediation analysis, 71.3% of the association between BMI and CVD was explained by the presence of metabolic syndrome.ConclusionsIn our elderly population, we found that the presence of obesity without metabolic syndrome did not confer a higher CVD risk. However, metabolic syndrome was strongly associated with CVD risk, and was associated with an increased risk in all BMI categories. Therefore, preventive interventions targeting cardiometabolic risk factors could be considered in elderly, regardless of weight status.
Highlights
Obesity in young individuals is an established risk factor for cardiovascular disease (CVD), the effect of obesity in the elderly seems to dilute with advancing age, rising towards controversial discussions [1, 2]
We found that the presence of obesity without metabolic syndrome did not confer a higher CVD risk
Metabolic syndrome was strongly associated with CVD risk, and was associated with an increased risk in all body mass index (BMI) categories
Summary
Obesity in young individuals is an established risk factor for cardiovascular disease (CVD), the effect of obesity in the elderly seems to dilute with advancing age, rising towards controversial discussions [1, 2]. It is well known that the presence of metabolic syndrome (a cluster of cardiovascular risk factors including hypertension, dyslipidemia, hyperglycemia and abdominal obesity) differs among individuals with similar body mass index (BMI), which indicates that the risk of CVD within specific categories of BMI could be heterogeneous [3, 4]. In this context, recent interest has focused on a subgroup of obese individuals, termed the metabolically healthy obese (MHO), who despite their increased BMI (BMI30kg/m2) seem to have an adequate metabolic profile and do not have metabolic syndrome[3, 5]. We examined the association of being MHO with CVD risk in the elderly
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