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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 08; 6(3)JA

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 P<0.0001). 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 P<0.0001).

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.

Authors+Show Affiliations

Estudo 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.Data Coordinating Center, Boston University School of Public Health, Boston, MA.Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.Department of Biostatistics, Boston University School of Public Health, Boston, MA.Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.Department of Epidemiology, Boston University School of Public Health, Boston, MA. Boston University's and the NHLIBI's Framingham Heart Study, Framingham, MA. Sections of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.Boston University's and the NHLIBI's Framingham Heart Study, Framingham, MA.Department of Epidemiology, Boston University School of Public Health, Boston, MA. Boston University's and the NHLIBI's Framingham Heart Study, Framingham, MA. Sections of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.Data Coordinating Center, Boston University School of Public Health, Boston, MA.Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany. DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany.Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Germany. DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany.Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

28275071

Citation

Brant, Luisa C C., et al. "Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community-Based Cohorts: a Meta-Analysis." Journal of the American Heart Association, vol. 6, no. 3, 2017.
Brant LC, Wang N, Ojeda FM, et al. Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community-Based Cohorts: A Meta-Analysis. J Am Heart Assoc. 2017;6(3).
Brant, L. C., Wang, N., Ojeda, F. M., LaValley, M., Barreto, S. M., Benjamin, E. J., Mitchell, G. F., Vasan, R. S., Palmisano, J. N., Münzel, T., Blankenberg, S., Wild, P. S., Zeller, T., Ribeiro, A. L., Schnabel, R. B., & Hamburg, N. M. (2017). Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community-Based Cohorts: A Meta-Analysis. Journal of the American Heart Association, 6(3). https://doi.org/10.1161/JAHA.116.004199
Brant LC, et al. 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) PubMed PMID: 28275071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community-Based Cohorts: A Meta-Analysis. AU - Brant,Luisa C C, AU - Wang,Na, AU - Ojeda,Francisco M, AU - LaValley,Michael, AU - Barreto,Sandhi M, AU - Benjamin,Emelia J, AU - Mitchell,Gary F, AU - Vasan,Ramachandran S, AU - Palmisano,Joseph N, AU - Münzel,Thomas, AU - Blankenberg,Stefan, AU - Wild,Philipp S, AU - Zeller,Tanja, AU - Ribeiro,Antonio L P, AU - Schnabel,Renate B, AU - Hamburg,Naomi M, Y1 - 2017/03/08/ PY - 2017/3/10/entrez PY - 2017/3/10/pubmed PY - 2018/2/16/medline KW - body mass index KW - cardiovascular risk factors KW - cohort studies KW - endothelial function KW - metabolic syndrome JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 6 IS - 3 N2 - 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 P<0.0001). 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 P<0.0001). 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. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/28275071/Relations_of_Metabolically_Healthy_and_Unhealthy_Obesity_to_Digital_Vascular_Function_in_Three_Community_Based_Cohorts:_A_Meta_Analysis_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.116.004199?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -