title: Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community-Based Cohorts: A Meta-Analysis.
abstract: BACKGROUND
  Microvascular dysfunction is a marker of early vascular disease that predicts cardiovascular events. Whether metabolically healthy obese individuals have impaired microvascular function remains unclear. The aim of this study was to evaluate the relation of obesity phenotypes stratified by metabolic status to microvascular function.
  
  
  RESULTS
  We meta-analyzed aggregate data from 3 large cohorts (Brazilian Longitudinal Study of Adult Health, the Framingham Heart Study, and the Gutenberg Heart Study; n=16 830 participants, age range 19-90, 51.3% men). Regression slopes between cardiovascular risk factors and microvascular function, measured by peripheral arterial tonometry (PAT), were calculated. Individuals were classified as normal-weight, overweight, or obese by body mass index (BMI) and stratified by healthy or unhealthy metabolic status based on metabolic syndrome using the ATP-III criteria. Male sex, BMI, and metabolic risk factors were associated with higher baseline pulse amplitude and lower PAT ratio. There was stepwise impairment of vascular measures from normal weight to obesity in both metabolic status strata. Metabolically healthy obese individuals had more impaired vascular function than metabolically healthy normal-weight individuals (baseline pulse amplitude 6.12±0.02 versus 5.61±0.01; PAT ratio 0.58±0.01 versus 0.76±0.01, allP<0.0001). Metabolically unhealthy obese individuals had more impaired vascular function than metabolically healthy obese individuals (baseline pulse amplitude 6.28±0.01 versus 6.12±0.02; PAT ratio 0.49±0.01 versus 0.58±0.01, allP<0.0001).
  
  
  CONCLUSIONS
  Metabolically healthy obese individuals have impaired microvascular function, though the degree of impairment is less marked than in metabolically unhealthy obese individuals. Our findings suggest that obesity is detrimental to vascular health irrespective of metabolic status.
authors.affiliation: Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil luisabrant@gmail.com.
authors.forename: Luisa C C
authors.initials: LC
authors.lastname: Brant
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA.
authors.forename: Na
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Ojeda
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: LaValley
authors.affiliation: Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Sandhi M
authors.initials: SM
authors.lastname: Barreto
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA.|Boston University's and the NHLIBI's Framingham Heart Study, Framingham, MA.|Sections of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Boston University's and the NHLIBI's Framingham Heart Study, Framingham, MA.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA.|Boston University's and the NHLIBI's Framingham Heart Study, Framingham, MA.|Sections of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Palmisano
authors.affiliation: Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.|DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.|Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.|DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany.
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Antonio L P
authors.initials: AL
authors.lastname: Ribeiro
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck Kiel, Germany.
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.affiliation: Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA.
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008365:Manometry; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D000067329:Obesity, Metabolically Benign / Q000378:metabolism / Q000503:physiopathology*; D050177:Overweight / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D011673:Pulsatile Flow; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: body mass index; cardiovascular risk factors; cohort studies; endothelial function; metabolic syndrome