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@ARTICLE{Lassale:132494,
      author       = {C. Lassale and I. Tzoulaki and K. G. M. Moons and M.
                      Sweeting and J. Boer and L. Johnson and J. M. Huerta and C.
                      Agnoli and H. Freisling and E. Weiderpass and P. Wennberg
                      and D. L. van der A and L. Arriola and V. Benetou and H.
                      Boeing and F. Bonnet and S. M. Colorado-Yohar and G.
                      Engström and A. K. Eriksen and P. Ferrari and S. Grioni and
                      M. Johansson and R. Kaaks$^*$ and M. Katsoulis and V.
                      Katzke$^*$ and T. J. Key and G. Matullo and O. Melander and
                      E. Molina-Portillo and C. Moreno-Iribas and M. Norberg and
                      K. Overvad and S. Panico and J. R. Quirós and C. Saieva and
                      G. Skeie and A. Steffen and M. Stepien and A. Tjønneland
                      and A. Trichopoulou and R. Tumino and Y. T. van der Schouw
                      and W. M. M. Verschuren and C. Langenberg and E. Di
                      Angelantonio and E. Riboli and N. J. Wareham and J. Danesh
                      and A. S. Butterworth},
      title        = {{S}eparate and combined associations of obesity and
                      metabolic health with coronary heart disease: a
                      pan-{E}uropean case-cohort analysis.},
      journal      = {European heart journal},
      volume       = {39},
      number       = {5},
      issn         = {1522-9645},
      address      = {Oxford},
      publisher    = {Oxford University Press},
      reportid     = {DKFZ-2018-00181},
      pages        = {397 - 406},
      year         = {2018},
      abstract     = {The 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.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {323 - Metabolic Dysfunction as Risk Factor (POF3-323)},
      pid          = {G:(DE-HGF)POF3-323},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29020414},
      doi          = {10.1093/eurheartj/ehx448},
      url          = {https://inrepo02.dkfz.de/record/132494},
}