The long-term prognosis of heart diseases for different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies
- 71 Downloads
This meta-analysis aimed to assess the association of different categories of weight and metabolic status with risk of heart diseases including myocardial infarction (MI), cardiovascular diseases (CVDs), and heart failure (HF).
Data from relevant studies were identified systematically by searching PubMed and Scopus search engines up to 29 May 2018. Prospective studies were included in the analyses with metabolically healthy normal weight (MHNW) as the reference. Pooled RRs and 95% CI were calculated using random-effects or fixed-effect models when appropriate. Subgroup analysis was applied to define possible sources of heterogeneity.
Overall, 21 studies (n = 778,401 participants) were eligible for the present meta-analysis. Generally, the risk of CVDs for all metabolic phenotypes in metabolically unhealthy obese increased compared with the MHNW group. A significant positive association between all metabolic phenotypes and the risk of HF was also observed expect for MHOW (RR = 1.10, 95% CI: 0.60–2.00, P = 0.76) and MHO phenotypes (RR = 0.96, 95% CI: 0.25–3.77, P = 0.95). Moreover, MUHO phenotype was associated with greater risk of MI compared with the MHNW phenotype (RR = 1.82, 95% CI: 1.50–2.22, P < 0.001, respectively).
Our findings showed that all metabolically unhealthy phenotypes in different categories of weight were associated with increased incident of CVDs/HF and MI. Furthermore, healthy overweight and obese subjects had increased risk of CVDs.
KeywordsBMI Obesity Metabolic healthy Metabolic unhealthy Cardiovascular diseases Risk Myocardial infarction Heart failure
Adult Treatment Panel III
body mass index
Joint Committee for Developing Chinese Guidelines
Joint Interim Statement
fasting blood glucose
high-density lipoprotein cholesterol
homeostatic model assessment-insulin resistance
high-sensitivity C-reactive protein
low-density lipoprotein cholesterol
International Diabetes Federation
metabolically healthy normal weight
metabolically healthy obese
metabolically healthy overweight
metabolically unhealthy normal weight
metabolically unhealthy obese
metabolically unhealthy overweight
meta-analysis of observational studies in epidemiology
type 2 diabetes
World Health Organization
This study was supported by the Student’s Scientific Research Center, Tehran, Iran.
A.M. and S.S.-B. contributed to the study concept and design; H.M. and A.B. designed search strategy and screened papers. A.B., S.S.-B. and K.D. performed statistical analysis; A.M. wrote the first draft of manuscript; all authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.P. Poirier, T.D. Giles, G.A. Bray, Y. Hong, J.S. Stern, F.X. Pi-Sunyer et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 113(6), 898–918 (2006)CrossRefGoogle Scholar
- 7.R.P. Wildman, P. Muntner, K. Reynolds, A.P. McGinn, S. Rajpathak, J. Wylie-Rosett et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Arch. Intern. Med. 168(15), 1617–24 (2008)CrossRefGoogle Scholar
- 23.K.E. Kip, O.C. Marroquin, D.E. Kelley, B.D. Johnson, S.F. Kelsey, L.J. Shaw et al. Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women: a report from the Women’s Ischemia Syndrome Evaluation (WISE) study. Circulation 109(6), 706–13 (2004)CrossRefGoogle Scholar
- 45.U.I. Khan, D. Wang, R.C. Thurston, M. Sowers, K. Sutton-Tyrrell, K.A. Matthews et al. Burden of subclinical cardiovascular disease in “metabolically benign” and “at-risk” overweight and obese women: the Study of Women’s Health Across the Nation (SWAN). Atherosclerosis 217(1), 179–86 (2011)CrossRefGoogle Scholar