Association of Concurrent Changes in Metabolic Health and Weight on Cardiovascular Disease Risk: A Nationally Representative Cohort Study

Abstract

BackgroundThe combined effect of transitions of metabolic health and weight on cardiovascular disease (CVD) remains unclear. We aimed to examine the association of concurrent changes of metabolic health and weight on CVD over time.Methods and ResultsThe study population consisted of 205 394 from the Korean National Health Insurance Service. Metabolic health was determined by fasting serum glucose, total cholesterol, and blood pressure levels, while obesity was determined by body mass index. All participants were divided into either metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese, or metabolically unhealthy obese for each of the first (2002–2003) and second (2004–2005) health screening periods, after which participants were followed‐up for CVD from 2006 to 2015. Cox proportional hazards regression was used to determine adjusted hazard ratios (aHRs) and 95% CIs. Among initial MHNO participants, those who became metabolically healthy obese (aHR, 1.25; 95% CI, 1.10–1.41), metabolically unhealthy nonobese (aHR, 1.23; 95% CI, 1.15–1.31), and metabolically unhealthy obese (aHR, 1.34; 95% CI, 1.12–1.61) had elevated risk for CVD compared with those who remained MHNO. Conversely, improving metabolic health and obesity were associated with reduced CVD risk among initially metabolically unhealthy nonobese to secondary MHNO (aHR, 0.79; 95% CI, 0.73–0.84), metabolically unhealthy obese to MHNO (aHR, 0.68; 95% CI, 0.58–0.81), and metabolically unhealthy obese to metabolically healthy obese (aHR, 0.73; 95% CI, 0.66–0.80) participants.ConclusionsChanges toward metabolically unhealthy or obese states resulted in increased CVD risk. Improving metabolic health along with reducing weight may lead to decreased risk of CVD.

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Impaired metabolic health over‐time and high abdominal fat are prospectively associated with high‐sensitivity C‐reactive protein in children: The IDEFICS study

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A Bayesian Network Analysis of the Probabilistic Relationships Between Various Obesity Phenotypes and Cardiovascular Disease Risk in Chinese Adults: Chinese Population-Based Observational Study

“…Compared with previous studies, this work offers a more comprehensive picture that simultaneously describes the complex interrelationships between metabolic healthy or unhealthy phenotypes and 10-year CVD risk across BMI categories, as well as the relationships among CVD-related risk factors. Although several prospective cohort studies have focused on exploring the specific associations between CVD risk and metabolic health status and BMI categories [14,[45][46][47], or the dynamic risk in the transition from one phenotype to another [48][49][50], this work aimed to provide a general framework to understand the multiple association processes that can emerge from the complex interrelationships between these factors. In fact, compared with standard studies, the greatest advantage and strength of this BN methodological approach is the graphical clarification and visualization of the most probable pathways in these relationships from a multi-dependent perspective, without affecting the interpretability of the network.…”