Palatini, Paolo, Saladini, Francesca, Mos, Lucio, Vriz, Olga, Ermolao, Andrea, Battista, Francesca, Berton, Giuseppe, Canevari, Mattia, and Rattazzi, Marcello
To investigate the prevalence of metabolically healthy overweight/obesity and to study its longitudinal association with major adverse cardiovascular and renal events (MARCE). The study was conducted in 1210 young-to-middle-age subjects grouped according to their BMI and metabolic status. The risk of MARCE was evaluated during 17.4 years of follow-up. Forty-eight-percent of the participants had normal weight, 41.9% had overweight, and 9.3% had obesity. Metabolically healthy status was found in 31.1% of subjects with normal weight and in 20.0% of those with overweight/obesity. During the follow-up, there were 108 MARCE. In multivariate Cox analysis adjusted for confounders and risk factors, no association was found between MARCE and overweight/obesity (p = 0.49). In contrast, metabolic status considered as a two-class variable (0 versus at least one metabolic abnormality) was a significant predictor of MARCE (HR, 2.11; 95%CI, 1.21–3.70, p = 0.009). Exclusion of atrial fibrillation from MARCE (N = 87) provided similar results (HR, 2.11; 95%CI, 1.07–4.16, p = 0.030). Inclusion of average 24 h BP in the regression model attenuated the strength of the associations. Compared to the group with healthy metabolic status, the metabolically unhealthy overweight/obesity participants had an increased risk of MARCE with an adjusted HR of 2.33 (95%CI, 1.05–5.19, p = 0.038). Among the metabolically healthy individuals, the CV risk did not differ according to BMI group (p = 0.53). The present data show that the risk of MARCE is not increased in young metabolically healthy overweight/obesity suggesting that the clinical approach to people with high BMI should focus on parameters of metabolic health rather than on BMI. • Metabolically healthy status was found in 31.1% of normal weight subjects and in 20.0% of overweight/obesity subjects. • In a 17.4-year follow-up, the risk of MARCE was not increased in the metabolically healthy overweight/obese subjects. • In contrast, unhealthy metabolic status was a significant predictor of MARCE irrespective of baseline BMI. • Compared to healthy metabolic status, the metabolically unhealthy overweight/obese group had a 133% increase in risk. [ABSTRACT FROM AUTHOR]