AMSTERDAM – Obese women with no metabolic disorders had the same cardiovascular disease risk as their normal-weight counterparts, according to a 5-year follow-up of more than 260,000 Danish women in their early 30s.
Meanwhile, during the same follow-up period, women with metabolic disorders had a fourfold increase in cardiovascular disease risk, regardless of their body mass index, according to Dr. Michelle D. Schmiegelow, who presented her findings at the annual congress of the European Society of Cardiology.
The absolute risks were still low in this young population, but given the findings, Dr. Schmiegelow said that physicians should have an "increased awareness of these young metabolically healthy overweight and obese women, because there might be a window of opportunity in which they could change their lifestyle and thereby reduce their risk of metabolic disorders and possibly reduce the risk of cardiovascular disease substantially."
The study was one of several presented at the meeting addressing the ongoing discussions about the obesity paradox.
"If you want to rely on the question on what is my future CVD risk, it’s not as easy to just measure your body weight,’ said Dr. Diethelm Tschöpe of Ruhr University, Bochum, Germany, in a video interview. "It’s a complex situation, which consists of body weight, risk factors, comorbidities, and the genetic background, which at the moment is hard to measure."
Dr. Schmiegelow of Gentofte Hospital, Hellerup, Denmark, and her colleagues examined the risk of myocardial infarctions, ischemic stroke, and all-cause mortality in more than 260,000 women who had given birth between 2004 and 2010, at a mean age of 31 years old. These women were identified in a nationwide registry of birth records. The median follow-up was 5.5 years after childbirth.
The women were considered metabolically unhealthy is they had a hypertensive disorder such as gestational hypertension, preeclampsia, or hypertension; an abnormal glucose metabolism such as diabetes or gestational diabetes; or dyslipidemia.
They were separated to four groups based on metabolic health status and prepregnancy body mass index (BMI): Metabolically healthy with a BMI less than 25 kg/m2; metabolically health with a BMI greater than or equal to 25; metabolically unhealthy with a BMI less than 25; and metabolically unhealthy with a BMI of greater than or equal to 25.
Data were adjusted for age and calendar year. The combined primary endpoints were the risks of MI, ischemic stroke, and all-cause mortality, using the metabolically healthy women with a BMI of less than 25 as reference.
The incidence rate (IR) of the combined endpoints for the normal weight, metabolically healthy women was 0.41 (number of events equaled 375); obese but metabolically healthy women had an IR of .45 (n = 51), and rate ratio (RR) of 1.16; normal weight but metabolically unhealthy women had an IR of .91 (n = 175), RR of 2.11; and obese and metabolically unhealthy women had an IR of 1.25 (n = 86), with an RR of 2.81.
"When you have an obese individual in front of you, that should be the first step, figuring out what their risk profile is," said Dr. Schmiegelow. "If they have metabolic disorders, that means they’re at an increased risk. If they do not have metabolic disorders, that means they’re at an increased risk of developing that, and you should really try and motivate them to change their lifestyle."
Dr. Schmiegelow and Dr. Tschöpe had no disclosures.
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