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000132494 0247_ $$2doi$$a10.1093/eurheartj/ehx448
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000132494 041__ $$aeng
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000132494 1001_ $$aLassale, Camille$$b0
000132494 245__ $$aSeparate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.
000132494 260__ $$aOxford$$bOxford University Press$$c2018
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000132494 520__ $$aThe hypothesis of metabolically healthy obesity implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study (EPIC-CVD). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction (unhealthy) as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of metabolically healthy obesity, encouraging population-wide strategies to tackle obesity.
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000132494 7001_ $$aTzoulaki, Ioanna$$b1
000132494 7001_ $$aMoons, Karel G M$$b2
000132494 7001_ $$aSweeting, Michael$$b3
000132494 7001_ $$aBoer, Jolanda$$b4
000132494 7001_ $$aJohnson, Laura$$b5
000132494 7001_ $$aHuerta, José María$$b6
000132494 7001_ $$aAgnoli, Claudia$$b7
000132494 7001_ $$aFreisling, Heinz$$b8
000132494 7001_ $$aWeiderpass, Elisabete$$b9
000132494 7001_ $$aWennberg, Patrik$$b10
000132494 7001_ $$avan der A, Daphne L$$b11
000132494 7001_ $$aArriola, Larraitz$$b12
000132494 7001_ $$aBenetou, Vassiliki$$b13
000132494 7001_ $$aBoeing, Heiner$$b14
000132494 7001_ $$aBonnet, Fabrice$$b15
000132494 7001_ $$aColorado-Yohar, Sandra M$$b16
000132494 7001_ $$aEngström, Gunnar$$b17
000132494 7001_ $$aEriksen, Anne K$$b18
000132494 7001_ $$aFerrari, Pietro$$b19
000132494 7001_ $$aGrioni, Sara$$b20
000132494 7001_ $$aJohansson, Matthias$$b21
000132494 7001_ $$0P:(DE-He78)4b2dc91c9d1ac33a1c0e0777d0c1697a$$aKaaks, Rudolf$$b22$$udkfz
000132494 7001_ $$aKatsoulis, Michail$$b23
000132494 7001_ $$0P:(DE-He78)fb68a9386399d72d84f7f34cfc6048b4$$aKatzke, Verena$$b24$$udkfz
000132494 7001_ $$aKey, Timothy J$$b25
000132494 7001_ $$aMatullo, Giuseppe$$b26
000132494 7001_ $$aMelander, Olle$$b27
000132494 7001_ $$aMolina-Portillo, Elena$$b28
000132494 7001_ $$aMoreno-Iribas, Concepción$$b29
000132494 7001_ $$aNorberg, Margareta$$b30
000132494 7001_ $$aOvervad, Kim$$b31
000132494 7001_ $$aPanico, Salvatore$$b32
000132494 7001_ $$aQuirós, J Ramón$$b33
000132494 7001_ $$aSaieva, Calogero$$b34
000132494 7001_ $$aSkeie, Guri$$b35
000132494 7001_ $$aSteffen, Annika$$b36
000132494 7001_ $$aStepien, Magdalena$$b37
000132494 7001_ $$aTjønneland, Anne$$b38
000132494 7001_ $$aTrichopoulou, Antonia$$b39
000132494 7001_ $$aTumino, Rosario$$b40
000132494 7001_ $$avan der Schouw, Yvonne T$$b41
000132494 7001_ $$aVerschuren, W M Monique$$b42
000132494 7001_ $$aLangenberg, Claudia$$b43
000132494 7001_ $$aDi Angelantonio, Emanuele$$b44
000132494 7001_ $$aRiboli, Elio$$b45
000132494 7001_ $$aWareham, Nicholas J$$b46
000132494 7001_ $$aDanesh, John$$b47
000132494 7001_ $$aButterworth, Adam S$$b48
000132494 773__ $$0PERI:(DE-600)2001908-7$$a10.1093/eurheartj/ehx448$$gVol. 39, no. 5, p. 397 - 406$$n5$$p397 - 406$$tEuropean heart journal$$v39$$x1522-9645$$y2018
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