Association of obesity phenotypes with electrocardiographic subclinical myocardial injury in the general population

Clin Cardiol. 2019 Mar;42(3):373-378. doi: 10.1002/clc.23155. Epub 2019 Feb 6.


Background: As the debate continues about whether obesity in metabolically healthy individuals is associated with poor outcomes or not, investigating the association between the obesity phenotypes and markers of subclinical myocardial injury will help identify those at risk for future cardiovascular events (cardiovascular disease [CVD]).

Hypothesis: We hypothesize that obesity phenotypes including metabolically healthy obesity (MHO) is associated with subclinical myocardial injury (SC-MI).

Methods: This analysis included 3423 participants (57.85 ± 13.06 years, 53.3% women) without known CVD from National Health and Nutrition Examination Survey (NHANES) III. Multivariable logistic regression models were used to examine the cross-sectional association between four obesity phenotypes (metabolically healthy nonobese (MHNO) [reference], metabolically unhealthy nonobese (MUNO), MHO, and metabolically unhealthy obese (MUO) with SC-MI. SC-MI was defined from the 12-lead electrocardiogram as cardiac infarction/injury score ≥ 10 units. Metabolic syndrome (MetS) was defined according to the International Diabetes Federation consensus definition. Obesity was defined as body mass index ≥30 kg/m2 .

Results: MUO was associated with higher odds of SC-MI compared with MHNO (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.22-1.92, P = 0.0005). This association was stronger in men vs women (OR [95% CI]: 2.20 [1.58-2.07] vs 1.08 [0.79-1.48]), respectively; interaction P-value = 0.002) but was consistent in subgroups stratified by age and race. There was no significant association of MHO or MUNO with SC-MI compared with MHNO, but there was a trend toward higher odds of SC-MI in the MUNO group (P-value for trend across MHNO, MUNO, and MUO = 0.0002).

Conclusions: Our findings suggest that a combination of obesity and MetS confers worse prognosis and early preventive strategies aimed at weight loss and management of MetS components may decrease the risk of future poor outcomes.

Keywords: NHANES III; metabolic syndrome; metabolically healthy obesity; subclinical myocardial injury.

Publication types

  • Multicenter Study

MeSH terms

  • Cross-Sectional Studies
  • Electrocardiography*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Ischemia / epidemiology
  • Myocardial Ischemia / etiology*
  • Myocardial Ischemia / physiopathology
  • Nutrition Surveys*
  • Obesity / complications
  • Obesity / epidemiology*
  • Odds Ratio
  • Risk Factors
  • United States / epidemiology