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All-Cause and Cardiovascular Mortality Among Koreans: Effects of Obesity and Metabolic Health.
Am J Prev Med. 2015 Jul; 49(1):62-71.AJ

Abstract

INTRODUCTION

The effect of obesity on mortality in people with metabolic syndrome (MetS) risk factors, but without pre-existing diabetes; hypertension; or cardiovascular disease (CVD), is uncertain. The purpose of this study is to investigate the effect of obesity and MetS risk factors on CVD and all-cause mortality in an Asian cohort.

METHODS

This retrospective study included 275,867 Koreans (56.6% men) who participated in an occupational health program between 2002 and 2009. At baseline, four groups were defined, according to the absence/presence of obesity (defined by BMI < or ≥25, respectively) and zero or one or more MetS features, respectively: metabolically healthy non-obese (MHNO; reference group); metabolically healthy obese (MHO); metabolically unhealthy obese (MUO); and metabolically unhealthy non-obese (MUNO). Hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality at follow-up were estimated using Cox proportional hazards models.

RESULTS

During follow-up, 1,060 deaths (187 from CVD) occurred. After adjusting for age, sex, alcohol intake, exercise, and educational status, CVD mortality risk was not increased in the MHO group (HR=0.50, 95% CI=0.15, 1.66), whereas risk was increased in the MUO and MUNO groups (HR=1.81, 95% CI=1.12, 2.91; HR=1.84, 95% CI=1.15, 2.92, respectively). HRs for all-cause mortality in both obese groups were not different from the reference group. When subjects with prior diabetes, CVD, and hypertension were excluded, CVD mortality was not significantly different in the MUO and MUNO groups from the reference group.

CONCLUSIONS

Comorbid diabetes, hypertension, or CVD explain much of the increased risk of CVD mortality in obese individuals.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: kcmd.sung@samsung.com.Department of Occupational and Environmental Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Centre for Population Health Sciences, University of Edinburgh, Southampton General Hospital (University of Southampton) and Southampton National Institute for Health Research Biomedical Research Centre, Southampton, United Kingdom.Nutrition and Metabolism Unit, IDS Building, Southampton General Hospital (University of Southampton) and Southampton National Institute for Health Research Biomedical Research Centre, Southampton, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26094228

Citation

Sung, Ki-Chul, et al. "All-Cause and Cardiovascular Mortality Among Koreans: Effects of Obesity and Metabolic Health." American Journal of Preventive Medicine, vol. 49, no. 1, 2015, pp. 62-71.
Sung KC, Ryu S, Cheong ES, et al. All-Cause and Cardiovascular Mortality Among Koreans: Effects of Obesity and Metabolic Health. Am J Prev Med. 2015;49(1):62-71.
Sung, K. C., Ryu, S., Cheong, E. S., Kim, B. S., Kim, B. J., Kim, Y. B., Chung, P. W., Wild, S. H., & Byrne, C. D. (2015). All-Cause and Cardiovascular Mortality Among Koreans: Effects of Obesity and Metabolic Health. American Journal of Preventive Medicine, 49(1), 62-71. https://doi.org/10.1016/j.amepre.2015.02.010
Sung KC, et al. All-Cause and Cardiovascular Mortality Among Koreans: Effects of Obesity and Metabolic Health. Am J Prev Med. 2015;49(1):62-71. PubMed PMID: 26094228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - All-Cause and Cardiovascular Mortality Among Koreans: Effects of Obesity and Metabolic Health. AU - Sung,Ki-Chul, AU - Ryu,Seungho, AU - Cheong,Eun Sun, AU - Kim,Bum Soo, AU - Kim,Byung Jin, AU - Kim,Yong-Bum, AU - Chung,Pil-Wook, AU - Wild,Sarah H, AU - Byrne,Christopher D, PY - 2014/08/28/received PY - 2015/01/20/revised PY - 2015/02/18/accepted PY - 2015/6/22/entrez PY - 2015/6/22/pubmed PY - 2016/3/26/medline SP - 62 EP - 71 JF - American journal of preventive medicine JO - Am J Prev Med VL - 49 IS - 1 N2 - INTRODUCTION: The effect of obesity on mortality in people with metabolic syndrome (MetS) risk factors, but without pre-existing diabetes; hypertension; or cardiovascular disease (CVD), is uncertain. The purpose of this study is to investigate the effect of obesity and MetS risk factors on CVD and all-cause mortality in an Asian cohort. METHODS: This retrospective study included 275,867 Koreans (56.6% men) who participated in an occupational health program between 2002 and 2009. At baseline, four groups were defined, according to the absence/presence of obesity (defined by BMI < or ≥25, respectively) and zero or one or more MetS features, respectively: metabolically healthy non-obese (MHNO; reference group); metabolically healthy obese (MHO); metabolically unhealthy obese (MUO); and metabolically unhealthy non-obese (MUNO). Hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality at follow-up were estimated using Cox proportional hazards models. RESULTS: During follow-up, 1,060 deaths (187 from CVD) occurred. After adjusting for age, sex, alcohol intake, exercise, and educational status, CVD mortality risk was not increased in the MHO group (HR=0.50, 95% CI=0.15, 1.66), whereas risk was increased in the MUO and MUNO groups (HR=1.81, 95% CI=1.12, 2.91; HR=1.84, 95% CI=1.15, 2.92, respectively). HRs for all-cause mortality in both obese groups were not different from the reference group. When subjects with prior diabetes, CVD, and hypertension were excluded, CVD mortality was not significantly different in the MUO and MUNO groups from the reference group. CONCLUSIONS: Comorbid diabetes, hypertension, or CVD explain much of the increased risk of CVD mortality in obese individuals. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/26094228/All_Cause_and_Cardiovascular_Mortality_Among_Koreans:_Effects_of_Obesity_and_Metabolic_Health_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(15)00074-4 DB - PRIME DP - Unbound Medicine ER -