Metabolic Health Maintenance Key to Preventing Cardiovascular Disease

A man measuring his waist circumference
A man measuring his waist circumference
Regardless of long-term metabolic health maintenance, obesity remains a risk factor for cardiovascular disease.

Obesity is a risk factor for cardiovascular disease (CVD), even when metabolic health is maintained, but the risk for CVD is particularly high in women who are “metabolically unhealthy” across all body mass index (BMI) categories, according to a study published in The Lancet Diabetes & Endocrinology.

Investigators examined the association between change in metabolic health over time and cardiovascular disease risk across all categories of BMI using data from the Nurses’ Health Study (NHS). The cohort included 90,257 women who completed a questionnaire in 1980 and were followed up from 1980 to 2010 for incident CVD.

At median follow-up of 24 years, 6306 cases of CVD were identified, including 3304 patients with myocardial infarction and 3080 patients with stroke.

Risk for CVD in women with metabolically healthy obesity was higher vs women with metabolically healthy normal weight (hazard ratio [HR] 1.39; 95% CI, 1.15-1.68). However, risk for CVD was much greater in women with metabolically unhealthy normal weight (HR 2.43; 95% CI, 2.19-2.68), who were overweight (HR 2.61; 95% CI, 2.36-2.89), or who were obese (HR 3.15; 95% CI, 2.83-3.50).

After 20 years, most of the metabolically healthy women converted to unhealthy phenotypes (2555 [84%] of 3027 women with obesity and 22,215 [68%] of 32,882 women with normal weight). Women who were obese but stayed metabolically healthy were still at increased risk for CVD vs women with stable healthy normal weight (HR 1.57; 95% CI, 1.03-2.38), but this risk was lower than that seen in women who were initially metabolically healthy but converted to an unhealthy phenotype.

“Most women with metabolic health are likely to convert to a metabolically unhealthy phenotype over time, which is associated with an increased [CVD] risk,” concluded the investigators.

Related Articles


Eckel N, Li Y, Kuxhaus O, Stefan N, Hu FB, Schulze MB. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study [published online May 30, 2018]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(18)30137-2