Metabolically Healthy Obesity Still Carries Increased Risk of Heart Failure, Arrhythmia

New data presented at EASD 2021 suggests patients with metabolically healthy obesity were at a 34% greater risk of developing new-onset heart failure and a 33% greater risk of new-onset AF than counterparts of healthy weight and no metabolic abnormalities.

An analysis of a national database of French hospitals suggests metabolically healthy obesity was associated with an increased risk of developing heart failure, but not myocardial infarction or stroke.

A look at data from more than 2.9 million patients with a mean follow-up of 4.9 years, results of the study demonstrate patients with obesity are at an increased risk of new-onset heart failure and atrial fibrillation than their counterparts of healthy weight and without metabolic abnormalities.

“This new and best available evidence tells us that on a population level, the idea that large numbers of people can be obese but metabolically healthy is simply untrue”, said lead investigator Laurent Fauchier, MD, PhD, of the Centre Hospitalier Universitaire Trousseau in France, in a statement. “Encouraging weight loss in people with obesity, regardless of whether or not they are metabolically healthy, will help prevent atrial fibrillation and heart failure.”

As the obesity crisis and the burden it imposes on health systems continuing to grow throughout the world, filling knowledge gaps related to cardiovascular risks among these patients could contribute to improvements in care and outcomes among patients with obesity in the future. More recently, the concept of metabolically healthy obesity has become a research focus for many diabetologists and other providers.

Fauchier and a team of colleagues from multiple European institutions sought to assess potential associations between metabolically healthy obesity and incident cardiovascular events at a nationwide level. Presented at the Annual Meeting of the European Association for the Study of Diabetes, the current study was designed to evaluate associations between risk of cardiovascular conditions with specific phenotypes defined by obesity and 3 metabolic abnormalities.

Using medical record data of all patients admitted to French hospitals from January-December 2013 with at least 5 years of follow-up and without a history of major adverse cardiovascular events (MACE), investigators identified 2,953,816 individuals with a mean follow-up of 4.9 years for inclusion in their analyses. Of the 2.9 million included in the analysis, 9.5% (n=272,838) were obese. Of note, patients considered underweight or malnourished were not included in the analysis.

Specific outcomes of interest for the analysis included MACE-HF, cardiovascular death, myocardial infarction, ischemic stroke, new-onset heart failure, and new-onset atrial fibrillation. Models used to calculate hazard ratios were adjusted based on age, sex, and smoking status at baseline. Investigators pointed out the 3 conditions used to define metabolic abnormalities were diabetes, hypertension, and hyperlipidemia.

During the follow-up period, investigators identified 510,439 incidences of new major cardiovascular events, including 77,924 myocardial infarctions, 391,637 cases of new-onset heart failure, 84,042 ischemic strokes, and 100,633 instances of cardiovascular death. Additionally, 257,287 patients were diagnosed with atrial fibrillation during the follow-up period.

In adjusted analyses, results indicated obese individuals with no metabolic abnormalities had a higher risk of MACE-HF (aHR, 1.22 [95% CI, 1.19-1.24]), new-onset heart failure (aHR, 1.34 [95% CI, 1.31-1.37]), and new-onset atrial fibrillation (aHR, 1.33 [95% CI, 1.30-1.37]) compared to individuals without obesity and 0 metabolic abnormalities. However, investigators pointed out there were no increases in risk seen for myocardial infarction (aHR, 0.92 [95% CI, 0.87-0.98]), ischemic stroke (aHR, 0.93 [95% CI, 0.88-0.98]), and cardiovascular death (aHR, 0.99 [95% CI, 0.93-1.04]).

Further analysis indicated obesity was independently associated with an increased risk of MACE-HF events (aHR, 1.13 [95% CI, 1.12-1.14]), of new-onset HF (aHR, 1.19 [95% CI, 1.18-1.20]) and new-onset atrial fibrillation (aHR, 1.29 [95%CI, 1.28-1.31]). This association was not observed for cardiovascular death (aHR, 0.96 [95% CI, 0.94-0.98]), myocardial infarction (HR, 0.93 [95%CI 0.91-0.95]) and ischemic stroke (aHR, 0.93 [95% CI, 0.91-0.96]). Investigators noted results suggested hypertension and diabetes mellitus were independent predictors of all outcomes examined in the study.

“Our findings also highlight the importance of preventing poor metabolic health and suggest that even normal weight individuals may benefit from early behavioural and medical management to improve their diet and increase physical activity in order to guard against stroke,” Fauchier added.

This study, “Metabolically healthy obese and cardiovascular events in a nationwide cohort study,” was presented at EASD 2021 and published in Diabetologia.