Статья

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

Camille LassaleDepartment of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UKIoanna TzoulakiDepartment of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UKKarel G.M. MoonsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, The NetherlandsMichael SweetingDepartment of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UKJolanda M.A. BoerNational Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The NetherlandsLaura JohnsonCentre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Senate House, Tyndall Ave, Bristol BS8 1TH, UKJosé María HuertaCIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, SpainClaudia AgnoliEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, ItalyHeinz FreislingSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, FranceElisabete WeiderpassDepartment of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, NorwayPatrik WennbergDepartment of Public Health and Clinical Medicine, Family medicine, Umeå University, 901 87 Umeå, SwedenDaphne L. van der ANational Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The NetherlandsLarraitz ArriolaPublic Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, Calle Doctor Begiristain, 20014 Donostia/Gipuzkoa, SpainVassiliki BenetouDepartment of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, School of Medicine, National and Kapodistrian University of Athens, Athens 157 72, GreeceHeiner BoeingDepartment of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114, 14558 Nuthetal, GermanyFabrice BonnetInserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP), U1018, 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, FranceSandra M. Colorado‐YoharDepartment of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, SpainGunnar EngströmDepartment of Clinical Sciences Malmö, Lund University, Bergsgatan 31 B, 214 45 Malmö, SwedenAnne Kirstine EriksenDiet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, DenmarkPietro FerrariSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, FranceSara GrioniEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, ItalyMatthias JohanssonSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, FranceRudolf KaaksDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, GermanyMichail KatsoulisHellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 115 27, Athens, GreeceVerena KatzkeDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, GermanyTimothy J. KeyCancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Old Road Campus, Oxford OX3 7LF, UKGiuseppe MatulloDepartment of Medical Sciences, University of Turin, Via Giuseppe Verdi, 8, 10124 Turin, ItalyOlle MelanderDepartment of Clinical Sciences Malmö, Lund University, Bergsgatan 31 B, 214 45 Malmö, SwedenElena Molina‐PortilloCIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, SpainConcepción Moreno-IribasMargareta NorbergDepartment of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, SwedenKim OvervadDepartment of Cardiology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, DenmarkSalvatore PanicoDipartimento di Medicina Clinica e Chirurgia, Federico II University, Corso Umberto I, 40, 80138 Naples, ItalyJ. Ramón QuirósPublic Health Directorate, Asturias, General Elorza 32, 33001 Oviedo, SpainCalogero SaievaCancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Via Cosimo Il Vecchio, 2, 50139 Florence, ItalyGuri SkeieDepartment of Community Medicine, University of Tromsø-the Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, NorwayAnnika SteffenDepartment of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114, 14558 Nuthetal, GermanyMagdalena StępieńSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, FranceAnne TjønnelandDiet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, DenmarkAntonia TrichopoulouDepartment of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, School of Medicine, National and Kapodistrian University of Athens, Athens 157 72, GreeceRosario TuminoCancer Registry and Histopathology Unit, Civic-M.P. Arezzo Hospital, ASP Contrada Rito, 97100 Ragusa, ItalyYvonne T. van der SchouwJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, The NetherlandsW. M. Monique VerschurenJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, The NetherlandsClaudia LangenbergMedical Research Council Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UKEmanuele Di AngelantonioDepartment of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UKElio RíboliDepartment of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UKNicholas J. WarehamMedical Research Council Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UKJohn DaneshDepartment of Human Genetics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UKAdam S. ButterworthDepartment of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UK

2017en

ABI

Аннотация

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.

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Идентификаторы

DOI: 10.1093/eurheartj/ehx448

Цитирования и источники

Цитирований: 2Использованных источников: 0

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