CVD risk high in individuals who once had metabolically healthy obesity

While obesity has inherent adverse effects on cardiometabolic parameters and cardiovascular disease (CVD) risk factors, metabolically healthy obesity (MHO) has emerged as a categorization of obese individuals who may not be at increased CVD risk because of relatively normal levels of lipids, blood pressure, and glucose.

An increasing body of research, however, including the present study by Dr. Mongraw-Chaffin and colleagues, highlights “dangers and long-term outcomes” of the MHO phenotype, Dr. Prakash Deedwania and Dr. Carl J. Lavie wrote in an editorial.

The analysis of 6,809 individuals in the Multi-Ethic Study of Atherosclerosis found that MHO is not a stable condition, as almost one-half of individuals developed metabolic syndrome over 12.2 years of follow-up, they noted.

Moreover, CVD risk was indeed elevated in these individuals with “unstable” MHO.

“Clearly, therefore, prevention of obesity in the first place is most prudent,” Dr. Deedwania and Dr. Lavie said in their editorial. “Prevention of progressive weight gain over time among the overweight and mildly obese is also of high importance to prevent development of metabolic syndrome and subsequent risk of CVD.”

If individuals with MHO can be identified early, the authors said, there is an excellent opportunity for primary prevention through lifestyle changes, including weight loss and regular physical exercise that might prevent MHO from converting to metabolically unhealthy obesity.

“Such population-wide healthy interventions are the only hope of preventing the oncoming tsunami of metabolic syndrome, diabetes, and CVD,” the editorial authors concluded.

Prakash Deedwania, MD, is with the University of California at San Francisco School of Medicine Program at Fresno. Carl J. Lavie, MD, is with the John Ochsner Heart and Vascular Institute, New Orleans, and the University of Queensland in Brisbane, Australia. These comments are derived from their editorial in the Journal of the American College of Cardiology ( 2018 May 1;71[17]:1866-8) . Both authors reported they had no relevant relationships to disclose.