Metabolically "healthy" obesity in postmenopausal women: Unmasking the cardiovascular risk

The concept of metabolically healthy obesity (MHO) has attracted growing attention, but its clinical relevance and association with future cardiovascular risk remain unclear. Estrogen deficiency, which signifies the menopause phase, contributes to altered body composition and unfavorable metabolic processes. In this Editorial, we comment on the recent retrospective study by Pingili et al, which used a United States national in-patient population and observed significantly elevated odds of major adverse cardiac and cerebrovascular events in postmenopausal women with MHO compared with their age-matched non-obese counterparts. Of note, disproportionately greater risks were particularly observed among Black patients. These findings along with previous literature data call into question the seemingly benign profile of the MHO state. Obese individuals who appear metabolically healthy present an elevated cardiovascular risk which may be exacerbated in older female populations. These findings emphasize the need for vigilance and improved approaches of risk stratification which would translate into the early application of preventive measures.