Background: It is unclear whether the “metabolically healthy” obese phenotype has low cardiovascular disease (CVD) risk. High-sensitivity cardiac troponin T (hs-cTnT), a biomarker of myocardial damage, characterizes subclinical CVD risk. We categorized obesity phenotypes and studied their cross-sectional and prospective associations with subclinical and clinical CVD.

Methods: We included 11,844 adults in the Atherosclerosis Risk in Communities (ARIC) Study. We used ATP III metabolic syndrome criteria and BMI to define obesity phenotypes as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO).

Results: At baseline (1990-1992), mean age was 56 years, 56% were female and 23% black. The MHO group was more likely to have detectable hs-cTnT (≥ 6 ng/L) than the MHNO (OR 1.23, 1.02-1.49). During over 26 years of follow-up, 3,560 participants developed CVD. The metabolically unhealthy and obese phenotypes had higher CVD risk than MHNO (Table). Detectable hs-cTnT was associated with higher CVD risk in all phenotypes; MHO had CVD risk, which was intermediate between MHNO and MUO regardless of hs-cTnT (Table).

Conclusion: Our results show that metabolically “healthy” obesity is associated with substantial excess burden of subclinical and clinical CVD. Lifestyle modification among obese adults, regardless of metabolic status, is vital to prevent CVD.


Y. Commodore-Mensah: None. M. Lazo: None. O. Tang: None. J.B. Echouffo Tcheugui: None. C.E. Ndumele: None. V. Nambi: Other Relationship; Self; Dynamed, Merck & Co., Inc., Roche Diagnostic USA. C.M. Ballantyne: Consultant; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Esperion, Gilead Sciences, Inc., Matinas BioPharma, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Research Support; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen Inc., Esperion, Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Other Relationship; Self; Roche Diagnostic USA. D. Wang: None. E. Selvin: None.


National Institutes of Health (5KL2TR001077-05)

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