Incident cardiovascular disease events in metabolically benign obese individuals

Document Type



Family Medicine


Objective: While several studies have demonstrated a high prevalence of metabolically benign obesity, little is known about the incidence of cardiovascular disease (CVD) in this group.
Research design and methods: Using pooled data from the Atherosclerosis Risk in Communities and Cardiovascular Health Studies, we assessed the association of metabolically benign obesity with incident CVD (coronary heart disease and stroke) using three existing definitions of metabolically benign obesity: (1) the ATP-III metabolic syndrome definition (≤2 of the ATP-III components, excluding waist), (2) the expanded ATP-III definition (≤1 of: the ATPIII components, HOMA-IR>75th percentile, systemic inflammation [WBC>75th percentile]), and (3) the insulin resistance (IR) based definition (sex-specific lowest quartile of the HOMA-IR distribution among non-diabetic obese).
Results: The sample included 4,323 normal weight and 6,121 obese individuals. Among obese, 27.0%, 18.1%, and 20.4% were metabolically benign by the three definitions, respectively. CVD incidence among metabolically benign obese defined by the three definitions (mean followup 11.8 years) was 8.7%, 7.2%, and 10.3%, respectively, versus 7.9% in low-risk normal weight individuals. Multivariate-adjusted hazard ratios (95% CI) of incident CVD in metabolically benign obese compared to low-risk normal weight individuals were 1.24 (0.99-1.57), 1.16 (0.86-1.56), and 1.28 (1.01-1.62), respectively.
Conclusions: Regardless of the definition used, we observed a high prevalence of metabolically benign obesity. All three commonly used definitions were similar in terms of both classification and subsequent risk of CVD, with the expanded ATP-III criteria perhaps identifying the obese group at lowest risk of CVD


This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Obesity(Silver Spring)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.