Insulin resistance syndrome, body mass index and the risk of ischemic heart disease

St‐Pierre, Annie; Cantin, Bernard; Mauriège, Pascale; Bergeron, Jean; Dagenais, Gilles R.; Després, Jean‐Pierre; Lamarche, Benoı̂t

doi:10.1503/cmaj.1040834

Cited by 132 publications

(118 citation statements)

References 16 publications

(12 reference statements)

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“…In accord with our findings, despite inconsistencies in the definitions of MH, the majority have found CVD risk to not be increased in MH OB compared with MH NW individuals (18,26,29,32,33,34,35), or have found CVD risk to be lower in MH OB compared with MUH OB (36), but not all studies agree (10). Moreover, several studies have found evidence for increased risk in MH OB compared with MH NW individuals in studies with >15 years follow-up (17,19,37).…”

Section: Discussionsupporting

confidence: 85%

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

Kaur

Johnston

Godsland

2016

European Journal of Endocrinology

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Objective: Overweight and obese individuals may be metabolically healthy, but attention needs to be given to long-term persistence of this trait and any associated variation in cardiovascular risk. Design: Cross-sectional and longitudinal variation in metabolic health and associated cardiovascular mortality were analysed in 1099 white European-origin normal-weight and overweight or obese males followed for 20 years. Methods: Definitions of metabolic health were based on LDL and HDL cholesterol, triglycerides, blood pressure, fasting glucose and cardiovascular risk. Insulin resistance (e.g. HOMA-IR) and sub-clinical inflammation (ESR and white blood cell count) were explored. Cardiovascular mortality risks and persistence of metabolic health status were evaluated. Results: There were 87 cardiovascular deaths. Insulin resistance was increased in metabolically healthy overweight or obese participants (median HOMA-IR 2.63, 95% CI: 1.79-3.65, P < 0.001) relative to normal-weight participants (median HOMA-IR 1.67, 95% CI: 1.08-2.67, P < 0.001) as was sub-clinical inflammation but metabolically healthy overweight or obese individuals were not at increased risk of cardiovascular mortality compared with the metabolically healthy normal-weight individuals (hazard ratio 1.13, 95% CI: 0.34-3.72, P = 0.8). The proportions of initially metabolically healthy overweight or obese who remained metabolically healthy for visits 2, 3 and 4 were 54, 48 and 39% respectively, and for initially normal-weight individuals, 68, 51 and 41%. A lower proportion of metabolically healthy overweight or obese individuals remained metabolically healthy at visit 2 compared with normal-weight individuals (P = 0.007), but proportions converged thereafter. Conclusions: Despite being insulin resistant and having greater sub-clinical inflammation, and despite instability in metabolic health status, metabolically healthy overweight or obese individuals were at no greater risk of cardiovascular mortality than their normal-weight equivalents.

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Section: Discussionsupporting

confidence: 85%

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

Kaur

Johnston

Godsland

2016

European Journal of Endocrinology

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Section: Introductionmentioning

confidence: 99%

“…6 Previous studies indicate that MHO individuals, regardless of body mass index, are not at increased risk for cardiovascular diseases compared with normal-weight subjects without insulin resistance. 7,8 Therefore, weight loss may not be deemed necessary among these individuals.Recent longitudinal studies have observed that obese men without metabolic syndrome were at an increased risk for cardiovascular events or death compared with normal-weight individuals without metabolic syndrome. 9,10 Other studies observed that the MHO subset had an intermediate cardiovascular risk between healthy non-obese subjects and insulin resistant subjects.…”

mentioning

confidence: 99%

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men

et al. 2011

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OBJECTIVES: Although the existence of metabolically healthy obese (MHO) individuals has been recognized, little is known regarding metabolic health status in these subjects over time. Thus, we evaluated longitudinal changes in metabolic parameters among MHO subjects compared with metabolically healthy, normal-weight (MHNW) subjects. METHODS: A cohort study was performed on 2599 Korean men, 30 --59 years of age, with no evidence of fatty liver disease on ultrasound and no traits of metabolic syndrome at baseline. BMI was categorized based on criteria for Asian population. Study participants were followed annually or biennially between 2002 and 2009. At each visit, the fatty liver on ultrasound was assessed and metabolic abnormalities were measured. Parametric Cox models and a pooled logistic regression models were used to evaluate the relationships of BMI with incident metabolic abnormalities. RESULTS: During 9647.1 person-years of follow-up, 1673 participants developed metabolic abnormalities. After adjusting for age, smoking, alcohol intake and exercise, higher baseline BMI categories predicted increased incidences of metabolic abnormalities in a dose-response manner. The hazard ratios (95% confidence intervals) for hypertriglyceridemia, prediabetes, pre-hypertension, low high-density lipoprotein-cholesterol, fatty liver, elevated high sensitivity-C reactive protein, elevated homeostasis model assessment of insulin resistance, any metabolic abnormality and metabolic syndrome among the MHO subjects compared with the MHNW subjects were 1.51 (1. Keywords: body mass index; risk factors; insulin resistance; metabolic syndrome X; follow-up studies INTRODUCTIONObesity is a risk factor for cardiometabolic disorders such as type 2 diabetes mellitus and cardiovascular disease. 1,2 However, the incidence of obesity-related metabolic disturbances varies widely among obese individuals. 3,4 A unique subset of obese individuals that appears to be protected from obesity-related metabolic abnormalities has been identified. 3,5 These individuals, referred to as metabolically healthy but obese (MHO), are relatively insulin sensitive and have a favorable cardiovascular risk profile despite excessive body fat. 6 Previous studies indicate that MHO individuals, regardless of body mass index, are not at increased risk for cardiovascular diseases compared with normal-weight subjects without insulin resistance. 7,8 Therefore, weight loss may not be deemed necessary among these individuals.Recent longitudinal studies have observed that obese men without metabolic syndrome were at an increased risk for cardiovascular events or death compared with normal-weight individuals without metabolic syndrome. 9,10 Other studies observed that the MHO subset had an intermediate cardiovascular risk between healthy non-obese subjects and insulin resistant subjects. 11,12 Furthermore, recent intervention studies showed that lifestyle-induced weight loss among MHO individuals was associated with improved insulin sensitivity. 13,14

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“…It has been suggested that the proportion of individuals without central obesity who have three or more components of the metabolic syndrome is small (3,4). It is also felt that in the U.S., for the most part, the same individuals will be identified by either definition so that differences in the definitions are probably insignificant (2).…”

mentioning

confidence: 99%

Should Central Obesity Be an Optional or Essential Component of the Metabolic Syndrome?

Lee

Heng

et al. 2007

Diabetes Care

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OBJECTIVE -The International Diabetes Federation (IDF) proposes that central obesity is an "essential" component of the metabolic syndrome, while the American Heart Association/ National Heart, Lung, and Blood Institute (AHA/NHLBI) proposes that central obesity is an "optional" component. This study examines the effect of the metabolic syndrome with and without central obesity in an Asian population with ischemic heart disease (IHD). RESEARCH DESIGN AND METHODS-From the population-based cohort study (baseline 1992-1995), 4,334 healthy individuals were grouped by the presence or absence of the metabolic syndrome and central obesity and followed up for an average of 9.6 years by linkage with three national registries. Cox's proportional hazards model was used to obtain adjusted hazard ratios (HRs) for risk of a first IHD event.RESULTS -The prevalence of metabolic syndrome was 17.7% by IDF criteria and 26.2% by AHA/NHLBI criteria using Asian waist circumference cutoff points for central obesity. Asian Indians had higher rates than Chinese and Malays. There were 135 first IHD events. Compared with individuals without metabolic syndrome, those with central obesity/metabolic syndrome and no central obesity/metabolic syndrome were at significantly increased risk of IHD, with adjusted HRs of 2.8 (95% CI 1.8 -4.2) and 2.5 (1.5-4.0), respectively. CONCLUSIONS -Having metabolic syndrome either with or without central obesity confers IHD risk. However, having central obesity as an "optional" rather than "essential" criterion identifies more individuals at risk of IHD in this Asian cohort.

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Insulin resistance syndrome, body mass index and the risk of ischemic heart disease

Cited by 132 publications

References 16 publications

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men

Should Central Obesity Be an Optional or Essential Component of the Metabolic Syndrome?

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