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Obesity phenotype and cardiovascular changes

Park, Juria; Kim, Seong H.b; Cho, Goo-Yeongc; Baik, Inkyungd; Kim, Nan H.e; Lim, Hong E.f; Kim, Eung J.f; Park, Chang G.f; Lim, Sang Y.b; Kim, Yong H.b; Kim, Hyung; Lee, Seung K.g; Shin, Cholg

doi: 10.1097/HJH.0b013e32834a50f3
Original papers: Obesity

Objective: Healthy obese phenotype with favorable metabolic profiles is proposed. However, whether healthy obesity leads to target organ changes is controversial. We investigated the impact of a healthy obesity on cardiovascular structure and function.

Methods: A total of 2540 participants without known cardiovascular disease were enrolled. According to BMI and the metabolic syndrome (MetS) component, the participants were divided into six groups: healthy (none of five MetS components) normal weight (BMI <23 kg/m2), unhealthy (one or more of five MetS components) normal weight, healthy overweight (BMI 23–24.9 kg/m2), unhealthy overweight, healthy obesity (BMI ≥25 kg/m2), and unhealthy obesity. The cardiovascular changes were assessed by echocardiography, tissue Doppler imaging (TDI), carotid ultrasonography, and pulse wave velocity (PWV).

Results: In a multivariate analysis after adjusting for age, sex, heart rate, high-sensitivity C-reactive protein, and medication for hypertension and diabetes mellitus, the unhealthy overweight and obese groups showed statistically significant changes in the left ventricular mass index, mitral E/A ratio, E/Ea ratio, TDI Ea velocity, common carotid artery intima–media thickness (CCA-IMT), and brachial-ankle PWV (P < 0.001), compared with the healthy normal weight individuals. In the healthy overweight and obese groups, CCA-IMT and brachial-ankle PWV values were similar, but left-ventricular mass index and TDI Ea velocity were significantly different (P < 0.001).

Conclusion: Healthy obesity was associated with subtle changes in left ventricular structure and function. These data provide evidence that metabolically healthy phenotypes with excess weight may not be a benign condition.

aDivision of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul

bDivision of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan

cDivision of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam

dDepartment of Foods and Nutrition, Kookmin University, Seoul

eDivision of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan

fDivision of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul

gInstitute of Human Genomic Study, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea

Correspondence to Seong H. Kim, MD, PhD, Division of Cardiology, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 516 Gojan-1-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, KoreaTel: +82 31 412 5546; fax: +82 31 412 5594; e-mail: cardioguy@korea.ac.kr

Abbreviations: CCT-IMT, common carotid artery intima-media thickness; HDL, high-density lipoprotein; HOMA-IR, Homeostasis Model Assessment Insulin Resistance Index; hs-CRP, high-sensitivity C-reactive protein; LV, left ventricle; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; MetS, metabolic syndrome; NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III; PWV, pulse wave velocity; TDI, tissue Doppler imaging

Received 16 March, 2011

Revised 30 May, 2011

Accepted 27 June, 2011

© 2011 Lippincott Williams & Wilkins, Inc.