Combined effect of obesity and cardio-metabolic abnormality on the risk of cardiovascular disease: A meta-analysis of prospective cohort studies

Jingyao Fan, Yiqing Song, Yu Chen, Rutai Hui, Weili Zhang

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Background Cardiovascular risk is inconsistent in the normal-weight, overweight, and obese individuals due to metabolic abnormality. We aimed to investigate combined effects of obesity and metabolic abnormality on the risk of cardiovascular disease and mortality. Methods The MEDLINE, EMBASE, Cochrane library, and references of relevant original articles prior to May 2013 were searched for prospective studies investigating cardiovascular risk and death associated with combined effects of obesity and metabolic syndrome or insulin resistance. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects or fixed-effect models when appropriate. Results Fourteen perspective studies with a total of 299,059 participants and 12,125 cases of incident CVD, 2130 cases of CVD death, and 7071 cases of all-cause death were included in the meta-analysis. Compared with healthy normal-weight individuals, metabolically healthy overweight (MHOW) and obese (MHOB) individuals showed increased risk for CVD events, which appeared much stronger during the long-term follow-up period of > 15 years, with pooled RR of 1.47 (95% CI 1.37-1.58) in MHOW and 2.00 (95% CI 1.79-2.24) in MHOB. Normal-weight but metabolically abnormal individuals were at increased risk for CVD (pooled RR 1.81, 95% CI 1.56-2.10), CVD-related death (pooled RR 1.55, 95% CI 1.16-2.08), and all-cause death (pooled RR 1.27, 95% CI 1.10-1.47). Metabolically abnormal obese individuals were at the highest risk for CVD and mortality. Conclusion Individuals with metabolic abnormality, although at normal-weight, had an increased risk of CVD and mortality. Healthy overweight and obese persons had higher risk, which refuted the notion that metabolically healthy obese phenotype is a benign condition.

Original languageEnglish (US)
Pages (from-to)4761-4768
Number of pages8
JournalInternational Journal of Cardiology
Volume168
Issue number5
DOIs
StatePublished - Oct 12 2013
Externally publishedYes

Fingerprint

Meta-Analysis
Cohort Studies
Cardiovascular Diseases
Obesity
Prospective Studies
Confidence Intervals
Weights and Measures
Mortality
Cause of Death
MEDLINE
Libraries
Insulin Resistance
Phenotype

Keywords

  • Cardiovascular disease
  • Metabolic syndrome
  • Metabolically healthy
  • Mortality
  • Obesity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Combined effect of obesity and cardio-metabolic abnormality on the risk of cardiovascular disease : A meta-analysis of prospective cohort studies. / Fan, Jingyao; Song, Yiqing; Chen, Yu; Hui, Rutai; Zhang, Weili.

In: International Journal of Cardiology, Vol. 168, No. 5, 12.10.2013, p. 4761-4768.

Research output: Contribution to journalArticle

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abstract = "Background Cardiovascular risk is inconsistent in the normal-weight, overweight, and obese individuals due to metabolic abnormality. We aimed to investigate combined effects of obesity and metabolic abnormality on the risk of cardiovascular disease and mortality. Methods The MEDLINE, EMBASE, Cochrane library, and references of relevant original articles prior to May 2013 were searched for prospective studies investigating cardiovascular risk and death associated with combined effects of obesity and metabolic syndrome or insulin resistance. Pooled relative risks (RR) and 95{\%} confidence intervals (CI) were calculated using random-effects or fixed-effect models when appropriate. Results Fourteen perspective studies with a total of 299,059 participants and 12,125 cases of incident CVD, 2130 cases of CVD death, and 7071 cases of all-cause death were included in the meta-analysis. Compared with healthy normal-weight individuals, metabolically healthy overweight (MHOW) and obese (MHOB) individuals showed increased risk for CVD events, which appeared much stronger during the long-term follow-up period of > 15 years, with pooled RR of 1.47 (95{\%} CI 1.37-1.58) in MHOW and 2.00 (95{\%} CI 1.79-2.24) in MHOB. Normal-weight but metabolically abnormal individuals were at increased risk for CVD (pooled RR 1.81, 95{\%} CI 1.56-2.10), CVD-related death (pooled RR 1.55, 95{\%} CI 1.16-2.08), and all-cause death (pooled RR 1.27, 95{\%} CI 1.10-1.47). Metabolically abnormal obese individuals were at the highest risk for CVD and mortality. Conclusion Individuals with metabolic abnormality, although at normal-weight, had an increased risk of CVD and mortality. Healthy overweight and obese persons had higher risk, which refuted the notion that metabolically healthy obese phenotype is a benign condition.",
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AU - Zhang, Weili

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AB - Background Cardiovascular risk is inconsistent in the normal-weight, overweight, and obese individuals due to metabolic abnormality. We aimed to investigate combined effects of obesity and metabolic abnormality on the risk of cardiovascular disease and mortality. Methods The MEDLINE, EMBASE, Cochrane library, and references of relevant original articles prior to May 2013 were searched for prospective studies investigating cardiovascular risk and death associated with combined effects of obesity and metabolic syndrome or insulin resistance. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects or fixed-effect models when appropriate. Results Fourteen perspective studies with a total of 299,059 participants and 12,125 cases of incident CVD, 2130 cases of CVD death, and 7071 cases of all-cause death were included in the meta-analysis. Compared with healthy normal-weight individuals, metabolically healthy overweight (MHOW) and obese (MHOB) individuals showed increased risk for CVD events, which appeared much stronger during the long-term follow-up period of > 15 years, with pooled RR of 1.47 (95% CI 1.37-1.58) in MHOW and 2.00 (95% CI 1.79-2.24) in MHOB. Normal-weight but metabolically abnormal individuals were at increased risk for CVD (pooled RR 1.81, 95% CI 1.56-2.10), CVD-related death (pooled RR 1.55, 95% CI 1.16-2.08), and all-cause death (pooled RR 1.27, 95% CI 1.10-1.47). Metabolically abnormal obese individuals were at the highest risk for CVD and mortality. Conclusion Individuals with metabolic abnormality, although at normal-weight, had an increased risk of CVD and mortality. Healthy overweight and obese persons had higher risk, which refuted the notion that metabolically healthy obese phenotype is a benign condition.

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