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Published on: September 27, 2024
Relationship between metabolic status, physical activity and cardiovascular disease in participants with obesity
Yingxin Liu1, Ai Zhao2, Guiju Sun3
1Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.
Insights
Metabolically healthy obesity (MHO) and physical activity (PA) independently reduce cardiovascular disease (CVD) risk in obese adults. PA also modifies the link between metabolic status and CVD risk, highlighting its importance.
Area of Science:
- Cardiovascular disease epidemiology
- Obesity and metabolic health
- Physical activity and health outcomes
Background:
- Obesity is a significant risk factor for cardiovascular disease (CVD).
- Metabolic status and physical activity (PA) are key factors influencing health in individuals with obesity.
- Understanding the interplay between metabolic health, PA, and CVD risk is crucial for targeted interventions.
Purpose of the Study:
- To investigate the independent and combined effects of metabolic status and physical activity (PA) on cardiovascular disease (CVD) risk.
- To examine how physical activity modifies the association between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) with CVD risk.
Main Methods:
- A cohort study of 109,301 adults with obesity, free of baseline CVD, from the UK Biobank.
- Participants classified into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) groups.
- Physical activity (PA) categorized into none, low, medium, and high levels of moderate-to-vigorous PA (MVPA); Cox regression models used for analysis.
Main Results:
- Metabolically healthy obesity (MHO) was associated with a 42% reduced risk of CVD compared to metabolically unhealthy obesity (MUO).
- Physical activity (PA) significantly decreased CVD risk among individuals with MUO.
- The lowest CVD risk was observed in the MHO group with medium PA levels, compared to MUO with no PA.
Conclusions:
- Both MHO and any level of moderate-to-vigorous PA (MVPA) are linked to a lower risk of CVD in obese adults.
- Physical activity (PA) plays a crucial role in modifying the relationship between metabolic status and CVD risk in individuals with obesity.
Objective:
We aimed to investigate the independent and joint associations between metabolic status, PA (physical activity) and risk of CVD (cardiovascular disease) in participants with obesity.
Methods:
We included 109,301 adults with obesity free of baseline CVD enrolled from 2006 to 2010 in the UK Biobank cohort (aged 56 ± 7.9 years). Based on metabolic status, obesity was grouped into metabolically healthy obesity (MHO; free of hypertension, hypercholesterolemia and diabetes; n = 26,989; BMI 33 ± 3.3 kg/m2) and metabolically unhealthy obesity (MUO; n = 82,312; BMI 34 ± 4.0 kg/m2). PA was categorized into four groups according to moderate-to-vigorous PA (MVPA): none, low, medium, and high. Multivariable Cox regression models were used for the main analyses adjusting for sociodemographic factors, lifestyles and comorbidities.
Results:
There were 8,059 CVD events during a median follow-up of 8.1 years. MHO was associated with a 42% reduced risk of CVD compared with MUO (HR = 0.58, 95% CI: 0.53-0.63). A significant interaction effect between PA and metabolic status on CVD risk was found. Among MUO participants, individuals with PA had significantly decreased CVD risk when compared with no MVPA (HR = 0.87, 95% CI: 0.81-0.94 for low PA; HR = 0.85, 95% CI: 0.78-0.93 for medium PA; and HR = 0.86, 95% CI: 0.80-0.92 for high PA). The lowest CVD risk was observed in MHO & medium PA group when compared with MUO & no MVPA (HR = 0.45, 95% CI: 0.37-0.56).
Conclusions:
Both MHO and any MVPA were associated with reduced risk of CVD in adults with obesity, while PA could modify the relationship between metabolic status and CVD risk.
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