Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis

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Separate and combined associations of obesity and metabolic health with coronary heart disease : a pan-European case-cohort analysis

Lassale, Camille (author): University College London,Imperial College London

Tzoulaki, Ioanna (author): Imperial College London,University of Ioannina

Moons, Karel G. M. (author): University Medical Center Utrecht,Human Genetics Foundation (HuGeF),University of Turin

Sweeting, Michael (author): University of Cambridge

Boer, Jolanda (author): National Institute for Public Health and the Environment (RIVM)

Johnson, Laura (author): University of Bristol

Huerta, José María (author): Murcia Regional Health Council,CIBER Epidemiology and Public Health (CIBERESP)

Agnoli, Claudia (author): Istituto Nazionale dei Tumori

Freisling, Heinz (author): International Agency for Research on Cancer, World Health Organization

Weiderpass, Elisabete (author): Karolinska Institute,Karolinska Institutet,UiT The Arctic University of Norway, Tromsø,Cancer Registry of Norway, Institute of Population-Based Cancer Research,Folkhälsan Research Center

Wennberg, Patrik (author): Umeå University,Umeå universitet,Allmänmedicin

van der A, Daphne L. (author): National Institute for Public Health and the Environment (RIVM),Biodonostia Health Research Institute

Arriola, Larraitz (author)

Benetou, Vassiliki (author): National and Kapodistrian University of Athens,Hellenic Health Foundation, Athens

Boeing, Heiner (author): German Institute of Human Nutrition

Bonnet, Fabrice (author): University of Rennes I,Centre for Research in Epidemiology and Population Health (CESP)

Colorado-Yohar, Sandra M. (author): Murcia Regional Health Council,University of Antioquia

Engström, Gunnar (author): Lund University,Lunds universitet,Kardiovaskulär forskning - epidemiologi,Forskargrupper vid Lunds universitet,Cardiovascular Research - Epidemiology,Lund University Research Groups

Eriksen, Anne K. (author): Danish Cancer Society

Ferrari, Pietro (author): International Agency for Research on Cancer, World Health Organization

Grioni, Sara (author): Istituto Nazionale dei Tumori

Johansson, Matthias (author): International Agency for Research on Cancer, World Health Organization

Kaaks, Rudolf (author): German Cancer Research Centre

Katsoulis, Michail (author): Hellenic Health Foundation, Athens

Katzke, Verena (author): German Cancer Research Centre

Key, Timothy J. (author): University of Oxford

Matullo, Giuseppe (author)

Melander, Olle (author): Lund University,Lunds universitet,Kardiovaskulär forskning - hypertoni,Forskargrupper vid Lunds universitet,Cardiovascular Research - Hypertension,Lund University Research Groups

Molina-Portillo, Elena (author): University of Granada,CIBER Epidemiology and Public Health (CIBERESP)

Moreno-Iribas, Concepción (author): Health Research Institute of Navarra (IDISNA)

Norberg, Margareta (author): Umeå University,Umeå universitet,Epidemiologi och global hälsa

Overvad, Kim (author): Aalborg University,Aarhus University

Panico, Salvatore (author): University of Naples Federico II

Quirós, J. Ramón (author): Public Health Directorate

Saieva, Calogero (author): Cancer Research and Prevention Institute (ISPO)

Skeie, Guri (author): UiT The Arctic University of Norway, Tromsø

Steffen, Annika (author): German Institute of Human Nutrition

Stepien, Magdalena (author): International Agency for Research on Cancer, World Health Organization

Tjønneland, Anne (author): Danish Cancer Society

Trichopoulou, Antonia (author): Hellenic Health Foundation, Athens,National and Kapodistrian University of Athens

Tumino, Rosario (author): Civic and M.P Arezzo Hospital

van der Schouw, Yvonne T. (author): University Medical Center Utrecht

Verschuren, W. M. Monique (author): National Institute for Public Health and the Environment (RIVM),University Medical Center Utrecht

Langenberg, Claudia (author): University of Cambridge

Di Angelantonio, Emanuele (author): University of Cambridge

Riboli, Elio (author): Imperial College London

Wareham, Nicholas J. (author): University of Cambridge

Danesh, John (author): Wellcome Trust Sanger Institute,University of Cambridge

Butterworth, Adam S. (author): University of Cambridge

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(creator_code:org_t)

2017-08-14
2018
English.
In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39:5, s. 397-406

Related links:: https://academic.oup...; show more...; http://dx.doi.org/10...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; https://lup.lub.lu.s...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Keyword

Adiposity
Coronary heart disease
Epidemiology
Metabolic syndrome
Obesity
Adiposity
Coronary heart disease
Epidemiology
Metabolic syndrome
Obesity

Publication and Content Type

ref (subject category)
art (subject category)

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By the author/editor: Lassale, Camille; Tzoulaki, Ioanna; Moons, Karel G. ...; Sweeting, Michae ...; Boer, Jolanda; Johnson, Laura; show more...; Huerta, José Mar ...; Agnoli, Claudia; Freisling, Heinz; Weiderpass, Elis ...; Wennberg, Patrik; van der A, Daphn ...; Arriola, Larrait ...; Benetou, Vassili ...; Boeing, Heiner; Bonnet, Fabrice; Colorado-Yohar, ...; Engström, Gunnar; Eriksen, Anne K.; Ferrari, Pietro; Grioni, Sara; Johansson, Matth ...; Kaaks, Rudolf; Katsoulis, Micha ...; Katzke, Verena; Key, Timothy J.; Matullo, Giusepp ...; Melander, Olle; Molina-Portillo, ...; Moreno-Iribas, C ...; Norberg, Margare ...; Overvad, Kim; Panico, Salvator ...; Quirós, J. Ramón; Saieva, Calogero; Skeie, Guri; Steffen, Annika; Stepien, Magdale ...; Tjønneland, Anne; Trichopoulou, An ...; Tumino, Rosario; van der Schouw, ...; Verschuren, W. M ...; Langenberg, Clau ...; Di Angelantonio, ...; Riboli, Elio; Wareham, Nichola ...; Danesh, John; Butterworth, Ada ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences; and Public Health Gl ...

Articles in the publication: European Heart J ...

By the university: Umeå University; Karolinska Institutet; Lund University

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