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Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three

Community-Based Cohorts: A Meta-Analysis

J Am Heart Assoc. 2017 Mar 8;6(3). pii: e004199. doi: 10.1161/JAHA.116.004199.

Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community-Based Cohorts: A Meta-Analysis.

Brant LC1, Wang N2, Ojeda FM3,4, LaValley M5, Barreto SM6, Benjamin EJ7,8,9, Mitchell GF8, Vasan RS7,8,9, Palmisano JN2, Münzel T10,11, Blankenberg S3,4, Wild PS12,13,11, Zeller T3,4, Ribeiro AL6, Schnabel RB3,4, Hamburg NM14.

Author information

1Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil luisabrant@gmail.com.

2Data Coordinating Center, Boston University School of Public Health, Boston, MA.

3Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.

4German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.

5Department of Biostatistics, Boston University School of Public Health, Boston, MA.

6Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

7Department of Epidemiology, Boston University School of Public Health, Boston, MA.

8Boston University’s and the NHLIBI’s Framingham Heart Study, Framingham, MA.

9Sections of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.

10Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.

11DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany.

12Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.

13Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.

14Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA.

Abstract

BACKGROUND:

Microvascular dysfunction is a marker of early vascular disease that predicts cardiovascular events. Whether metabolically healthy obese individuals have impaired microvascular function remains unclear. The aim of this study was to evaluate the relation of obesity phenotypes stratified by metabolic status to microvascular function.

METHODS AND RESULTS:

We meta-analyzed aggregate data from 3 large cohorts (Brazilian Longitudinal Study of Adult Health, the Framingham Heart Study, and the Gutenberg Heart Study; n=16 830 participants, age range 19-90, 51.3% men). Regression slopes between cardiovascular risk factors and microvascular function, measured by peripheral arterial tonometry (PAT), were calculated. Individuals were classified as normal-weight, overweight, or obese by body mass index (BMI) and stratified by healthy or unhealthy metabolic status based on metabolic syndrome using the ATP-III criteria. Male sex, BMI, and metabolic risk factors were associated with higher baseline pulse amplitude and lower PAT ratio. There was stepwise impairment of vascular measures from normal weight to obesity in both metabolic status strata. Metabolically healthy obese individuals had more impaired vascular function than metabolically healthy normal-weight individuals (baseline pulse amplitude 6.12±0.02 versus 5.61±0.01; PAT ratio 0.58±0.01 versus 0.76±0.01, all P0.0001). Metabolically unhealthy obese individuals had more impaired vascular function than metabolically healthy obese individuals (baseline pulse amplitude 6.28±0.01 versus 6.12±0.02; PAT ratio 0.49±0.01 versus 0.58±0.01, all P0.0001).

CONCLUSIONS:

Metabolically healthy obese individuals have impaired microvascular function, though the degree of impairment is less marked than in metabolically unhealthy obese individuals. Our findings suggest that obesity is detrimental to vascular health irrespective of metabolic status.

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