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Background <p>Individuals with excess body weight do not share the same risk for cardiovascular disease (CVD). The phenotype of metabolically healthy obesity (MHO) has drawn the attention of the scientific community due to a potentially reduced CVD risk compared with the phenotype of metabolically unhealthy obesity (MUO).</p> Methods <p>A prospective cohort study was conducted involving 3042 participants from the Attica region in Greece. Baseline demographic, clinical, and lifestyle characteristics were assessed, with participants categorized by their obesity and metabolic health status. Cox proportional hazards models were used to analyze the association between obesity/metabolic health status and 20-year CVD incidence, adjusting for relevant covariates.</p> Results <p>The sample at baseline comprised 38% individuals who were metabolically healthy without obesity (MHWO), 44% individuals who were metabolically unhealthy without obesity (MUWO), 6% individuals with MHO, and 12% individuals with MUO. Over the 20-year follow-up, 718 participants experienced a CVD event; participants with MUO demonstrated the highest incidence rate (61.1%). Cox regression analyses revealed that individuals with MUO had an 85% higher risk of developing CVD compared with individuals having the MHWO phenotype (HR = 1.85, 95% CI = 1.02–3.58). Individuals with MHO had a 39% elevated risk compared with individuals having the MHWO phenotype (HR = 1.39, 95% CI = 1.06–3.42). Groups with MHO and MUO had independently increased CVD risk, even after multivariable adjustment.</p> Conclusions <p>Individuals with MUO exhibit the highest risk, but individuals with MHO also have an independently increased CVD risk, emphasizing the significant impact of both obesity and metabolic health status on long-term CVD incidence.</p>

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Metabolically healthy obesity is independently associated with 20-year incidence of cardiovascular disease: findings from the ATTICA cohort study (2002–2022)

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  • 发表日期：

    2026年4月18日

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  • Theodosios D. Filippatos,
  • Panagiotis Katrapas,
  • Thomas Tsiampalis,
  • Christina Chrysohoou,
  • Fotios Barkas,
  • Evangelos Liberopoulos,
  • Petros P. Sfikakis,
  • Costas Tsioufis,
  • Christos Pitsavos,
  • Demosthenes Panagiotakos,
  • Elpiniki Vlachopoulou,
  • Christina Vafia,
  • Konstantina Kyrili,
  • Ekavi N. Georgousopoulou,
  • Agathi Ntzouvani,
  • Dimitris Mpougatsas,
  • Nikolaos Skourlis,
  • Christina Papanikolaou,
  • Georgia-Maria Kouli,
  • Aimilia Christou,
  • Adella Zana,
  • Maria Ntertimani,
  • Aikaterini Kalogeropoulou,
  • Evangelia Pitaraki,
  • Alexandros Laskaris,
  • Mihail Hatzigeorgiou,
  • Athanasios Grekas,
  • George Dedoussis,
  • Georgia Anastasiou,
  • Amalia Despoina Koutsogianni,
  • Evangelinos Michelis,
  • Manolis Kambaxis,
  • Kyriakos Dimitriadis,
  • Ioannis Andrikou,
  • Amalia Sofianidi,
  • Natalia Sinou,
  • Aikaterini Skandali,
  • Christina Sousouni,
  • Natassa Katinioti,
  • Labros Papadimitriou,
  • Konstantina Masoura,
  • Spiros Vellas,
  • Yannis Lentzas,
  • Konstantina Palliou,
  • Vassiliki Metaxa,
  • Efi Tsetsekou,
  • Carmen Vassiliadou,
  • Marina Toutouza-Giotsa,
  • Konstantina Tselika,
  • Sia Poulopoulou,
  • Maria Toutouza

摘要

Background

Individuals with excess body weight do not share the same risk for cardiovascular disease (CVD). The phenotype of metabolically healthy obesity (MHO) has drawn the attention of the scientific community due to a potentially reduced CVD risk compared with the phenotype of metabolically unhealthy obesity (MUO).

Methods

A prospective cohort study was conducted involving 3042 participants from the Attica region in Greece. Baseline demographic, clinical, and lifestyle characteristics were assessed, with participants categorized by their obesity and metabolic health status. Cox proportional hazards models were used to analyze the association between obesity/metabolic health status and 20-year CVD incidence, adjusting for relevant covariates.

Results

The sample at baseline comprised 38% individuals who were metabolically healthy without obesity (MHWO), 44% individuals who were metabolically unhealthy without obesity (MUWO), 6% individuals with MHO, and 12% individuals with MUO. Over the 20-year follow-up, 718 participants experienced a CVD event; participants with MUO demonstrated the highest incidence rate (61.1%). Cox regression analyses revealed that individuals with MUO had an 85% higher risk of developing CVD compared with individuals having the MHWO phenotype (HR = 1.85, 95% CI = 1.02–3.58). Individuals with MHO had a 39% elevated risk compared with individuals having the MHWO phenotype (HR = 1.39, 95% CI = 1.06–3.42). Groups with MHO and MUO had independently increased CVD risk, even after multivariable adjustment.

Conclusions

Individuals with MUO exhibit the highest risk, but individuals with MHO also have an independently increased CVD risk, emphasizing the significant impact of both obesity and metabolic health status on long-term CVD incidence.