Metabolically healthy obese phenotype and risk of cardiovascular disease: Results from the China Health and Retirement Longitudinal Study

Background: Epidemiologic evidence on metabolically healthy obese (MHO) phenotype and cardiovascular diseases (CVD) risk remains controversial. Aims: We aim to examine the relationship between MHO and risk of CVD among the Chinese population. Methods: The China Health and Retirement Longitudinal Study is a prospective cohort study of 7849 participants aged ≥45 years without CVD at baseline. Metabolic health status was assessed based on blood pressure, triglycerides, high-density lipoprotein cholesterol, glycated hemoglobin, fasting glucose, and C-reactive protein. A cutoff point of body mass index of 24.0 kg/m ² was used to define over-weight/obesity (≥24.0 kg/m ² ) or normal weight (<24.0 kg/m ² ). CVD was based on self-reported doctor's diagnosis of heart problems and stroke. Incidence rate ratio (IRR) with 95% confidence interval (CI) was deduced from modified Poisson regression. Results: During a mean 3.6 years of follow-up, 880 incident CVD events were recorded. 789 (10.05%) were identified MHO among 3321 (42.3%) obese individuals. Compared with metabolically healthy normal weight individuals, the multivariable adjusted IRR of CVD was 1.33 (95%CI: 1.19–1.49) for MHO, 1.29 (95%CI: 1.22–1.38) for metabolically unhealthy normal weight, and 1.61 (95%CI: 1.51–1.75) for metabolically unhealthy obese in the full adjusted model. Conclusions: MHO individuals are associated with the increased risk of cardiovascular diseases among the Chinese population.