Cardiovascular disease (CVD) risk in individuals with metabolically healthy obesity (MHO) is unclear. We searched databases from inception to May 2019. Data were pooled using a random effects model. Newcastle-Ottawa Scale assessment was performed. Primary and secondary outcomes were CVD risk and all-cause mortality. Forty-three studies involving 4,822,205 cases were included. The median percentage of females, age and duration of follow-up was 52%, 49.9 years and 10.6 years, respectively. The mean Newcastle-Ottawa Scale score of the articles was 7.9 ± 1.0. Compared to individuals with a metabolically healthy normal weight, individuals with MHO had higher adjusted risk of CVD and all-cause mortality. We identified a significant linear dose-response relationship between body mass index (BMI) and CVD risk among metabolically healthy individuals (p < 0.001); every unit increase in BMI increased the CVD risk. Multivariate meta-regression analysis showed that an increased proportion of women and age resulted in the risk of CVD affected by MHO reduction (p = 0.014, p = 0.030, respectively). Age and sex explained the observed heterogeneity and reported the adjusted R2. MHO resulted in a significantly increased risk for CVD; therefore, long-term weight loss should be encouraged.

We investigated the association among metabolically healthy obesity (MHO), cardiovascular disease (CVD)risk, and all-cause mortality in the Asian population. We searched databases from inception to 16 November, 2019 and pooled data using a random-effects model. Subgroup analysis was conducted according to the following comparison groups: MHNW (without overweight or underweight participants) and MHNO (non-obese, including overweight and underweight participants). Nineteen studies were included. The mean Newcastle–Ottawa Scale score was 7.8. Participants with MHO had a significantly higher CVD risk (odds ratio (OR) = 1.36, 95% confidence interval (CI) = 1.13–1.63) and significantly lower risk of all-cause mortality (OR = 0.88, 95% CI = 0.78–1.00) than the comparison group. Subgroup analyses revealed participants with MHO had a significantly higher CVD risk than MHNW participants (OR = 1.61; 95% CI = 1.24–2.08; I2 = 73%), but there was no significant difference compared with MHNO participants (OR, 1.04; 95% CI, 0.80–1.36; I2 = 68%). Participants with MHO had a significantly lower risk of all-cause mortality (OR = 0.83; 95% CI = 0.78–0.88; I2 = 9%) than MHNO participants, but a borderline significantly higher risk of all-cause mortality than MHNW participants (OR = 1.30; 95% CI = 0.99–1.72; I2 = 0%). The CVD risk and all-cause mortality of the MHO group changed depending on the control group. Thus, future studies should select control groups carefully.

Background. Metabolically healthy obesity (MHO) is defined as obesity with less than two parameters of metabolic abnormalities. Some studies report that MHO individuals show similar risk of cardiovascular disease (CVD) compared with metabolically healthy non-obese (MHNO) individuals, but the results are conflicting. Coronary artery calcium (CAC) reflects the extent of coronary atherosclerosis and is a useful tool to predict future risk of CVD. The objective of this meta-analysis was to investigate whether MHO is associated with elevated risk of CAC. Method. We searched Cochrane, PubMed, and Embase up to April 19, 2019. Prospective cohort and cross-sectional studies examining the association between MHO subjects and CAC were included with MHNO as the reference. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random-effect models. Subgroup analysis and meta-regression were applied to define possible sources of heterogeneity. We conducted this research following a pre-established protocol registered on PROSPERO (CRD 42019135006). Results. A total of nine studies were included in this review and six studies with 23,543 participants were eligible for the meta-analysis. Compared with MHNO subjects, MHO had a higher odds of CAC (OR 1.36, 95% CI [1.11 to 1.66]; I 2 = 39%). In the subgroup analysis, the risk associated with MHO participants was significant in cohort studies (OR = 1.47, 95% CI [1.15,1.87], I 2 = 0%), and borderline significant in crosssectional studies. The risk of CAC was also significant in MHO participants defined by Adult Treatment Panel III (ATP III) (OR = 1.55, 95% CI [1.25,1.93], I 2 = 0%). The univariate meta-regression model showed that age and smoking status were possible effect modifiers for MHO and CAC risk. Conclusion. Our meta-analysis showed that MHO phenotypes were associated with elevated risk of CAC compared with MHNO, which reflects the extent of coronary How to cite this article Hsueh Y-W, Yeh T-L, Lin C-Y, Tsai S-Y, Liu S-J, Lin C-M, Chen H-H. 2020. Association of metabolically healthy obesity and elevated risk of coronary artery calcification: a systematic review and meta-analysis. PeerJ 8:e8815 http://doi.org/10.7717/peerj.8815atherosclerosis. People with obesity should strive to achieve normal weight even when only one metabolic abnormality is present.

Hypertrophic cardiomyopathy (HCM) is an often under-diagnosed cause of left ventricular hypertrophy (LVH). It affects 1/500 of the population, is the most commonly inherited cardiovascular disorder, and can present in apical, concentric, or septal forms. Although most patients are asymptomatic, sudden cardiac death can be the initial presentation of HCM. By retrospectively enrolling patients suspected of having three different types of HCM in the absence of epicardial coronary stenosis, we aimed to examine systolic and diastolic dysfunction and perfusion abnormalities using both Doppler echocardiography and state-of-the-art gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera and thallium-201. Both regional perfusion and gated SPECT parameters were collected in addition to diastolic parameters from Doppler echocardiography. The results showed that mild ischemia was common in patients suspected of having HCM, with a mean summed stress score of 4.7 ± 4.9 (score 0–4 in 17-segment model). The patients with HCM were associated with discernible left ventricular mechanical dyssynchrony, especially those with the apical form. In addition, diastolic dysfunction was prevalent and early to late ventricular filling velocity ratios were significantly different between groups. By combining gated-MPI and Doppler data, the trivial functional changes in HCM may be identified.

parameters, including blood pressure [7][8][9] . However, research results on the relationship between smoking cessation and blood pressure vary. Some researchers found a paradoxical association between cigarette smoking and blood pressure, with current smokers showing lower blood pressure than ex-smokers 7,10 or non-smokers 10,11 . In one study, smokers had higher daytime ambulatory systolic blood pressure than ABSTRACT INTRODUCTION Cigarette smoking affects blood pressure and is a major risk factor for cardiovascular diseases. The role of smoking cessation programs with respect to blood pressure remains inconclusive. Thus, this study aimed to investigate the effects of a smoking cessation program on blood pressure. METHODS Participants who attended the smoking cessation program in an outpatient clinic of a tertiary medical center in Taiwan from 2017 to 2018 were enrolled in this retrospective cohort study. Their smoking cessation status was traced via phone calls during the third month, and the researchers collected participant characteristics and blood pressure before and after the program. Differences in the participants' blood pressure, based on those with and those without hypertension, were compared using analysis of covariance. Univariable logistic regression models were used to determine factors associated with success in smoking cessation. In total, there were 721 participants. The participants had a mean age of 55.8±11.4 years and 68.1% of the participants were hypertensive. RESULTS During the program, the overall systolic blood pressure decreased by 4.0±17.9 mmHg and diastolic blood pressure decreased by 2.5±12.0 mmHg, from the baseline. Hypertensive participants showed a more prominent blood pressure lowering effect compared to non-hypertensive participants in terms of the subtraction difference of systolic blood pressure (-5.0±19.0 vs -1.9±15.2 mmHg, p=0.018) and diastolic blood pressure (-3.1±12.9 vs -1.1±9.6 mmHg, p=0.016). After multivariate control, the results showed that the adjusted subtraction difference of diastolic blood pressure was still more significant in the hypertensive group than in the non-hypertensive group. CONCLUSIONS The smoking cessation program significantly reduced both systolic blood pressure and diastolic blood pressure in the entire cohort. The results were more significant in the hypertensive group compared to the non-hypertensive group.