Abstract
We aim to investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population. 37,180 participants with at least one-time measurement of branchial-ankle pulse wave velocity (baPWV) were included in the cross-sectional analysis, and 16,236 participants with repeated measurement of baPWV during the follow-ups were included in the longitudinal study. Cross-classification of body mass index (BMI) categories and metabolic health status created six groups. Linear and logistic regression analyses were used. The results of cross-sectional and longitudinal investigation were essentially the same, as the abnormality of baPWV increased with BMI categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants. A 1.4-fold, 2.2-fold increased risk for the new occurrence of arterial stiffness were documented in MHO and metabolically unhealthy obese participants compared to metabolically healthy normal-weight controls in the fully adjusted model. Further stratified analysis showed that metabolic health status was an interaction factor between BMI and arterial stiffness in all study populations (P=0.0001 for cross-sectional study and P=0.0238 for longitudinal study). In conclusion, metabolic health status and BMI categories contribute to the progression of arterial stiffness, while BMI is positively associated with arterial stiffness only in metabolically healthy participants.
Highlights
Branchial-ankle pulse wave velocity, a promising indicator of both central and peripheral arterial stiffness [1], has been proven to be strongly associated with cardio-cerebrovascular morbidity and mortality in a recent meta-analysis of 8 studies [2]
The results of cross-sectional and longitudinal investigation were basically the same, as the abnormality of Branchial-ankle pulse wave velocity (baPWV) increased with body mass index (BMI) categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants
A 1.6-fold, 2.8-fold increased risk for the new occurrence of arterial stiffness were documented in metabolically healthy obese (MHO) and metabolically unhealthy obese participants compared to metabolically healthy normal weight controls in the fully adjusted model
Summary
Branchial-ankle pulse wave velocity (baPWV), a promising indicator of both central and peripheral arterial stiffness [1], has been proven to be strongly associated with cardio-cerebrovascular morbidity and mortality in a recent meta-analysis of 8 studies [2]. Metabolic syndrome (MetS) is recognized as a cluster of risk factors for atherosclerotic cardiovascular disease (CVD), including hypertension, hyperlipidemia, hyperglycemia, and broadened waist circumference (WC) [4, 5]. A subset of obese individuals without MetS, identified as metabolically healthy obese (MHO), attracted extensive attention due to the inconsistency on cardiovascular risk. Some studies demonstrated that obesity status exerted no extra influence on CVD [12, 13]. Others indicated MHO was a transient condition between metabolically healthy and unhealthy phenotypes, and obesity was a risk factor for CVD regardless of the metabolic health status [14,15,16]. To investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population
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