Exploring And Comparing The Predictive Value Of A Novel Metabolically Healthy Obesity Criterion For Cardiovascular Disease Onset And Mortality In A Rural Northeast Chinese Population

Background and objective: Obesity has become a serious public health problem and brings a heavy burden of cardiovascular disease.Metabolically healthy obesity(MHO)is defined as obese individuals with no or only minor metabolic complications.Whether individuals with MHO have a lower cardiovascular risk remains controversial.In this study,a new criterion was used to define MHO and assess its predictive value for cardiovascular events and death.At the same time,the new criterion and the traditional criterion are compared to analyze the differences between different diagnostic criteria.Methods: We established a prospective cohort in rural northeast China from 2012 to2013.Information was collected at baseline by questionnaire,physical examination,and blood biochemical examination,and follow-up was conducted in 2015 and 2018 to investigate the incidence and survival of cardiovascular events.According to the new criteria for the diagnosis of metabolic health,subjects were divided into four groups according to whether they were metabolically healthy and obese.KaplanMeier curve was drawn to describe the cumulative risk of end-point events of subjects in the four groups,and differences between groups were compared using Log-Rank test.Cox regression analysis models were constructed to compare the risk of endpoint events in the four groups.Subsequently,metabolic health was re-diagnosed according to the traditional criterion,and subjects were re-divided into four groups combined with obesity status.Cox regression was again used to calculate the differences in the risk of complex cardiovascular events between the four groups. Variance analysis and post hoc analysis were used to calculate and compare the differences in metabolic markers between the new and traditional MHO subjects.Results: A total of 9345 participants 35 years of age or older without a history of cardiovascular disease were included after exclusion of participants who were lost to follow-up or had incomplete data.After a median follow-up of 4.66 years,we found that participants in the MHO group had no significant increase in the risk of composite cardiovascular events and stroke,but had a 162% increase in the risk of coronary heart disease(HR: 2.62;95%CI: 1.21-5.67).No statistically significant differences were observed in the risks of fatal cardiovascular events and all-cause death among the four study groups.However,when using conventional criteria for metabolic health,m MHO group had a 52% increase in composite cardiovascular risk(HR: 1.52;95%CI: 1.14-2.03).By comparing the differences of metabolic indicators between MHO subjects diagnosed by the two criteria,we found that MHO subjects diagnosed by the new criteria had higher WC,WHR,TG,FPG,and lower HDL-C levels in addition to lower blood pressure,showing more exposure to cardiovascular risk factors.Conclusions: The risk of complex cardiovascular events and stroke was not increased in metabolically healthy obese subjects,but the risk of coronary heart disease was increased.The new metabolic health criterion are superior to the traditional criteria and can effectively identify obese individuals with a lower risk of complex cardiovascular events.Blood pressure levels may be responsible for the inconsistent risk of complex cardiovascular events in MHO subjects diagnosed with both criteria.