BACKGROUND Previous studies have been unclear about the cardiovascular risks for metabolically healthy obese individuals. OBJECTIVES This study examined the associations among metabolically healthy obese individuals and 4 different presentations of incident cardiovascular disease in a contemporary population. METHODS We used linked electronic health records (1995 to 2015) in The Health Improvement Network (THIN) to assemble a cohort of 3.5 million individuals, 18 years of age or older and initially free of cardiovascular disease. We created body size phenotypes defined by body mass index categories (underweight, normal weight, overweight, and obesity) and 3 metabolic abnormalities (diabetes, hypertension, and hyperlipidemia). The primary endpoints were the first record of 1 of 4 cardiovascular presentations (coronary heart disease [CHD], cerebrovascular disease, heart failure, and peripheral vascular disease). RESULTS During a mean follow-up of 5.4 years, obese individuals with no metabolic abnormalities had a higher risk of CHD (multivariate-adjusted hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.45 to 1.54), cerebrovascular disease (HR: 1.07; 95% CI: 1.04 to 1.11), and heart failure (HR: 1.96; 95% CI: 1.86 to 2.06) compared with normal weight individuals with 0 metabolic abnormalities. Risk of CHD, cerebrovascular disease, and heart failure in normal weight, overweight, and obese individuals increased with increasing number of metabolic abnormalities. CONCLUSIONS Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities and similar risks for cardiovascular disease events.

中文翻译：

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350 万男性和女性中代谢健康的肥胖和心血管疾病事件

背景 先前的研究尚不清楚代谢健康的肥胖个体的心血管风险。目的 本研究调查了当代人群中代谢健康的肥胖个体与 4 种不同的心血管疾病表现之间的关联。方法 我们使用健康改善网络 (THIN) 中的关联电子健康记录（1995 年至 2015 年）收集了 350 万年龄在 18 岁或以上且最初没有心血管疾病的人的队列。我们创建了由体重指数类别（体重不足、体重正常、超重和肥胖）和 3 种代谢异常（糖尿病、高血压和高脂血症）定义的体型表型。主要终点是 4 次心血管表现（冠心病 [CHD]、脑血管疾病、心力衰竭和外周血管疾病）。结果 在平均 5.4 年的随访期间，没有代谢异常的肥胖个体患 CHD（多变量调整风险比 [HR]：1.49；95% 置信区间 [CI]：1.45 至 1.54）、脑血管疾病的风险更高（HR：1.07；95% CI：1.04 至 1.11）和心力衰竭（HR：1.96；95% CI：1.86 至 2.06）与代谢异常为 0 的正常体重个体相比。正常体重、超重和肥胖个体患冠心病、脑血管疾病和心力衰竭的风险随着代谢异常数量的增加而增加。结论 代谢健康的肥胖个体比正常体重代谢健康的个体有更高的冠心病、脑血管疾病和心力衰竭的风险。