Black Overweight Women Have Increased Cardiovascular Risk Even Without Metabolic Syndrome

Michelle Schmiegelow, MD, PhD-studerende Hjertemedicinsk Forskning Gentofte Universitetshospital Interview with:
Michelle Schmiegelow, MD, PhD-student
Hjertemedicinsk Forskning
Gentofte Universitetshospital

Medical Research: What is the background for this study?

Dr. SchmiegelowObesity has become a worldwide epidemic, but the excess cardiovascular risk observed in obese individuals may primarily be attributable to metabolic mediators, rather than obesity per se. Several studies conducted in primarily non-Hispanic white populations suggest that obese individuals without the metabolic syndrome, defined as metabolically healthy obese, have a cardiovascular risk similar to that of normal weight metabolically healthy individuals.

We used prospectively collected data from the Women’s Health Initiative studies to evaluate whether obesity unaccompanied by metabolic abnormalities was associated with increased risk of cardiovascular disease (CVD) across racial/ethnic subgroups in postmenopausal women. Additionally, we examined whether the use of the metabolic syndrome to define the metabolically healthy obese applied to the various racial/ethnic subgroups by quantifying the number and type of metabolic syndrome components.

All women were classified by obesity level and metabolic health status at baseline. The women were thus categorized according to body mass index (BMI, kg/m2) into normal weight (BMI 18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (30.0 kg/m2) women. Metabolic health status was first defined by presence of the metabolic syndrome (yes/no), and second by number of metabolic syndrome components. In accordance with the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute we defined the metabolic syndrome as any two of the following (criteria for women): increased waist circumference ≥80 cm; increased level of triglycerides ≥150 mg/dL (≥1.7 mM); decreased level of HDL-C <50 mg/dL (<1.3 mM); increased blood pressure with either systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, or treatment with antihypertensive drugs; and impaired fasting serum glucose ≥100 mg/dL (6.1 mM).

Medical Research: What are the main findings?

Dr. Schmiegelow: The study population comprised 14,364 women without diabetes or prior cardiovascular disease. The women had a median age of 64 years (interquartile range 57–69), and 47% were white, 36% were black and 18% were Hispanic. Over a median follow-up of 13 years (interquartile range 12–14 years), 1,101 women (7.7%) had a first cardiovascular event.

The main findings of this study were that metabolic abnormalities appeared to confer more cardiovascular risk among black women than among white women. Consistent with other studies, among white women without the metabolic syndrome, obesity was not associated with increased cardiovascular risk compared with normal weight women. Conversely, black overweight and black obese women had increased cardiovascular risk compared with normal weight black women without the metabolic syndrome, even in absence of the metabolic syndrome.

According to number of metabolic syndrome components, black overweight or obese women with just two metabolic abnormalities had increased risk of cardiovascular disease, although they would be considered “metabolically healthy” based on the standard definition, particularly since one of these abnormalities were abdominal obesity for 79% of overweight and 98% of obese women, irrespective of race/ethnicity. White obese women with three metabolic abnormalities did not have a statistically significantly increased cardiovascular risk compared with normal weight metabolically healthy women. Thus, cardiovascular disease risk appeared to be elevated in black women by the presence of only two or three metabolic abnormalities to a degree that would require four or more metabolic abnormalities among white women. These findings did not appear to be driven by any particular combination of metabolic abnormalities.

Medical Research: What should clinicians and patients take away from your report?

Dr. SchmiegelowIrrespective of race/ethnicity, cardiovascular risk appeared to be closer related to presence of metabolic abnormalities, than to the presence of obesity. Our findings emphasize that in assessment of an individual’s cardiovascular risk; an individualized approach should be encouraged in which the clinician considers the sum and type of metabolic syndrome components in light of the individual’s overall risk profile, particularly when applied to populations other than whites.

Importantly, obesity is closely correlated with increased risk of insulin resistance and risk of developing metabolic abnormalities, and several studies have shown that “metabolically healthy” obesity is not a stable condition emphasizing the importance of preventing the development of metabolic disorders.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. SchmiegelowSince our study population only included postmenopausal women, other studies are needed to explore whether our findings apply to men and younger women, and races/ethnicities other than non-Hispanic white and black. Regarding the latter, although Hispanic women comprised about 18% of the study population, there were too few events among the Hispanic women for precise estimates.


Race and Ethnicity, Obesity, Metabolic Health, and Risk of Cardiovascular Disease in Postmenopausal Women

Michelle D. Schmiegelow, Haley Hedlin, Rachel H. Mackey, Lisa W. Martin, Mara Z. Vitolins, Marcia L. Stefanick, Marco V. Perez, Matthew Allison, and Mark A. Hlatky

J Am Heart Assoc. 2015;4:e001695, originally published May 20, 2015, doi:10.1161/JAHA.114.001695


[wysija_form id=”3″] Interview with: Michelle Schmiegelow, MD, PhD-student (2015). Black Overweight Patients Have Increased Cardiovascular Risk Even Without Metabolic Syndrome

Last Updated on May 21, 2015 by Marie Benz MD FAAD