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Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis

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Title: Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis
Authors: Lassale, C
Tzoulaki, I
Moon, KGM
Sweeting, M
Boer, J
Johnson, L
Huerta, JM
Agnoli, C
Freisling, H
Weiderpass, E
Wennberg, P
Van der A, DL
Arriola, L
Benetou, V
Boeing, H
Bonnett, F
Colorado-Yohar, SM
Engstrom, G
Eriksen, AK
Ferrari, P
Grioni, S
Johansson, M
Kaaks, R
Katsoulis, M
Katzke, V
Key, TJ
Matullo, G
Melander, O
Molina-Portillo, E
Moreno-Iribas, C
Norberg, M
Overvad, K
Panico, S
Ramon Quiros, J
Saieva, C
Skeie, G
Steffen, A
Stepien, M
Tjonneland, A
Trichopoulou, A
Tumino, R
Van der Schouw, YT
Verschuren, WMM
Langenberg, C
Di Angelantonio, E
Riboli, E
Wareham, NJ
Danesh, J
Butterworth, AS
Item Type: Journal Article
Abstract: 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.
Issue Date: 14-Aug-2017
Date of Acceptance: 20-Jul-2017
URI: http://hdl.handle.net/10044/1/51612
DOI: https://dx.doi.org/10.1093/eurheartj/ehx448
ISSN: 1522-9645
Publisher: Oxford University Press (OUP)
Start Page: 397
End Page: 406
Journal / Book Title: European Heart Journal
Volume: 39
Issue: 5
Copyright Statement: © 2018 European Society of Cardiology
Sponsor/Funder: Imperial College Trust
Commission of the European Communities
Funder's Grant Number: P47328
279233
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Coronary heart disease
Adiposity
Obesity
Metabolic syndrome
Epidemiology
BODY-MASS INDEX
INCIDENT CARDIOVASCULAR-DISEASE
ALL-CAUSE MORTALITY
METABOLICALLY HEALTHY
FAT DISTRIBUTION
MENDELIAN RANDOMIZATION
CARDIOMETABOLIC TRAITS
PHYSICAL-ACTIVITY
POOLED ANALYSIS
RISK-FACTORS
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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