@article{23495,
  author = {Woodward Mark and Mongraw-Chaffin Morgana and Foster Meredith and Anderson Cheryl and Burke Gregory and Haq Nowreen and Kalyani Rita and Ouyang Pamela and Sibley Christopher and Tracy Russell and Vaidya Dhananjay},
  title = {Metabolically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk.},
  abstract = {<p><b>BACKGROUND: </b>Debate over the cardiometabolic risk associated with metabolically healthy obesity (MHO) continues. Many studies have investigated this relationship by examining MHO at baseline with longitudinal follow-up, with inconsistent results.</p><p><b>OBJECTIVES: </b>The authors hypothesized that MHO at baseline is transient and that transition to metabolic syndrome (MetS) and duration of MetS explains heterogeneity in incident cardiovascular disease (CVD) and all-cause mortality.</p><p><b>METHODS: </b>Among 6,809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) the authors used Cox proportional hazards and logistic regression models to investigate the joint association of obesity (≥30 kg/m) and MetS (International Diabetes Federation consensus definition) with CVD and mortality across a median of 12.2 years. We tested for interaction and conducted sensitivity analyses for a number of conditions.</p><p><b>RESULTS: </b>Compared with metabolically healthy normal weight, baseline MHO was not significantly associated with incident CVD; however, almost one-half of those participants developed MetS during follow-up (unstable MHO). Those who had unstable MHO had increased odds of CVD (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.14 to 2.25), compared with those with stable MHO or healthy normal weight. Dose response for duration of MetS was significantly and linearly associated with CVD (1 visit with MetS OR: 1.62; 95% CI: 1.27 to 2.07; 2 visits, OR: 1.92; 95% CI: 1.48 to 2.49; 3+ visits, OR: 2.33; 95% CI: 1.89 to 2.87; p value for trend <0.001) and MetS mediated approximately 62% (44% to 100%) of the relationship between obesity at any point during follow-up and CVD.</p><p><b>CONCLUSIONS: </b>Metabolically healthy obesity is not a stable or reliable indicator of future risk for CVD. Weight loss and lifestyle management for CVD risk factors should be recommended to all individuals with obesity.</p>},
  year = {2018},
  journal = {J Am Coll Cardiol},
  volume = {71},
  pages = {1857-1865},
  issn = {1558-3597},
  doi = {10.1016/j.jacc.2018.02.055},
  language = {eng},
}