Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population‐based cohort study

Abstract

BackgroundThe association between metabolic syndrome and increased cardiovascular disease (CVD) risk is well‐established. However, in patients with incident CVD, the relationship between obesity, metabolic health, and subsequent CVD and mortality outcomes are less well‐established. This study investigated the association between body mass index (BMI), metabolic health and the risk of subsequent cardiovascular mortality and morbidity outcomes in patients with incident CVD events.MethodsThis cohort study identified 130 685 patients from the nationwide Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases in the United Kingdom. Patients were ≥18 years with incident CVD [coronary heart disease (CHD), stroke, or peripheral vascular disease (PVD)] between 1 January 1998 and 31 December 2017. BMI (in kg/m2) was categorized as underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9) and obese (≥30). Within each BMI category, patients were grouped by increasing count of 1, 2 or 3 metabolic risk factors [RF] (dyslipidaemia, diabetes mellitus and hypertension) and were regarded as metabolically unhealthy while absence of these factors was considered metabolically healthy (MH). Multivariable Cox regression was used to assess the risk (hazard ratio with 95% confidence interval) of subsequent outcomes (non‐fatal CHD, stroke, PVD, incident heart failure, CVD‐mortality and all‐cause mortality) in BMI subgroups with incremental count of metabolic RFs.ResultsDuring a median follow‐up of 13.0 years, a higher BMI was associated with reduced risk for stroke, PVD, CVD‐mortality and all‐cause mortality within each metabolic risk category, while increasing metabolic RFs within each BMI subgroup accounted for increasing risks. When compared with patients with normal BMI and no RF, CVD‐mortality risk in overweight patients with no RF was 0.76 (0.70–0.84), and in obese patients with no RF was 0.85 (0.76–0.96). The respective risk for all‐cause mortality in patients with overweight and no RF was 0.69 (0.65–0.72), and in obese patients with no RF was 0.75 (0.70–0.79). Subsequent outcomes of stroke and PVD showed similar trends. In contrast, the risk of subsequent non‐fatal CHD events and incident HF increased with higher BMI and with incremental metabolic risk factors within each BMI category. Underweight was constantly associated with increased risk for all outcomes regardless of the presence of metabolic RFs except for non‐fatal CHD events.ConclusionsIn patients with incident CVD, overweight and obesity were related to a more favourable prognosis for subsequent stroke, PVD and mortality (CVD‐related and all‐cause) irrespective of the presence of other metabolic risk factors.

Rising Trends in Metabolically Healthy Obesity in Cancer Patients and Its Impact on Cardiovascular Events: Insights from a Contemporary Nationwide Analysis in the USA (2016–2020)

“…Akyea et al conducted a prospective population-based study following patients with incident cardiovascular disease (CVD) over a median of 13 years. Overweight individuals with no risk factors (RFs) [HR: 0.76 (95% CI: 0.70-0.84)] and obese individuals with no RFs [HR: 0.85 (95% CI: 0.76-0.96)] exhibited a decrease in CVD mortality risk compared to those with a normal BMI and no RFs [40]. Conversely, the likelihood of subsequent non-fatal coronary heart disease (CHD) events and the occurrence of incident heart failure (HF) increased concomitantly with rising BMI and additional metabolic risk factors within each BMI category [40].…”

Efectos cardiometabólicos de la pérdida de peso

“…En este sentido, varios estudios epidemiológicos retrospectivos y prospectivos han demostrado un efecto potencialmente protector de la obesidad cuando coexiste con ECV, lo que se ha denominado paradoja de la obesidad 1 , 29 , 30 , 31 . En una cohorte de más de 130.000 pacientes con ECV de nuevo diagnóstico en el Reino Unido, el sobrepeso y la obesidad se relacionaron con un pronóstico más favorable de ictus, enfermedad vascular periférica y mortalidad posteriores (tanto los relacionados con ECV como por cualquier causa), independientemente de la presencia de otros factores de riesgo metabólico 32 .…”

Oral supplementation of Njansan (Ricinodendron heudelotii Bail) and sardine fillets (Sardina pilchardus) oils alleviate high-fat diet-induced obesity in rats by regulating lipid metabolism and stress oxidative parameters

“…In Cameroon, there has been an increase in the percentage of obese adults, from 4.9% to 15.1%. 3 Obesity is associated with nearly 200 comorbidities, including cardio-metabolic disorders such as Type 2 diabetes, 4 cardiovascular diseases, 5 hypertension, 6 dyslipidemia, 7 gastrointestinal disorders, 8 mechanical disorders (osteoarthritis of weight-bearing joints, hypoventilation), numerous cancers, and mental health problems (depression), as well as functional limitations and a reduction in health-related quality of life. 1,6 It has also been reported to weaken COVID-19.…”