HealthDay News — Obesity is associated with increased risk of cardiovascular disease risk even among metabolically healthy women, according to a study published online May 30 in The Lancet Diabetes & Endocrinology.

Nathalie Eckel, from the German Institute of Human Nutrition Potsdam-Rehbruecke in Nuthetal, and colleagues followed 90,257 female nurses from 1980 to 2010 for incident cardiovascular disease. Participants were cross-classified by body mass index categories, metabolic health, and change in metabolic health status.

The researchers documented 6,306 cases of cardiovascular disease, including 3,304 myocardial infarction cases and 3,080 strokes, during 2,127,391 person-years of follow-up (median follow-up, 24 years). 

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Women with metabolically healthy obesity had elevated cardiovascular disease risk compared with women with metabolically healthy normal-weight (hazard ratio, 1.39); women with metabolically unhealthy normal-weight, overweight, and obesity had considerably higher risk (hazard ratios, 2.43, 2.61, and 3.15, respectively). Most metabolically healthy women converted to unhealthy phenotypes, including 84 and 68 percent of women with obesity and normal-weight, respectively, after 20 years. 

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Compared to women with stable healthy normal-weight, women who maintained metabolically healthy obesity during follow-up were still at elevated cardiovascular risk (hazard ratio, 1.57); this risk was lower than for initially metabolically healthy women who converted to an unhealthy phenotype (hazard ratios, 1.90 and 2.74 for normal-weight and obesity, respectively).

“Even when metabolic health is maintained during long periods of time, obesity remains a risk factor for cardiovascular disease,” the authors write.

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