Objective: Increasing evidence doubts the benign nature of metabolically healthy obesity (MHO). An investigation of the association of MHO and other obesity phenotypes with electrocardiographic left ventricular hypertrophy (ECG-LVH), a risk factor for cardiovascular disease (CVD), can give insight into the pathophysiological basis for increased risk of CVD linked to these phenotypes.
Methods: This analysis included 3997 participants (58.7 ± 13.6 years; 51.8% women) without CVD from the NHANES-III. Metabolic syndrome was defined according to the Adult Treatment Panel III. Obesity was defined as body mass index ≥30 kg/m2. Multivariable logistic regression was used to examine the cross-sectional association between 4 obesity phenotypes (metabolically healthy non-obese (MHNO) (reference), metabolically unhealthy non-obese (MUNO), MHO and metabolically unhealthy obese (MUO) with Cornell voltage ECG-LVH.
Results: There was an incremental increase in the prevalence of ECG-LVH across obesity phenotypes with the highest prevalence in the MUO followed by MHO, MUNO and then MHNO (ECG-LVH = 6.45%, 5%, 4.71%, and 1.69%, respectively, trend p-value < 0.001). Also, there was incremental increase in the strength of associations with ECG-LVH across obesity phenotypes with higher odds of ECG-LVH in the MUO (OR (95% CI): 4.12 (2.30-7.39) followed by MUNO (OR (95% CI): 2.62 (1.45-4.73) then MHO (OR (95% CI): 2.45 (1.11-5.43) compared to MHNO. The MHO association with ECG-LVH was stronger in men than women (OR (95% CI): 5.55 (1.49-20.70) vs. 1.94 (0.71-5.24) respectively; interaction p-value = 0.04).
Conclusions: Obesity phenotypes including MHO are associated with ECG-LVH, thus further questioning the concept of benign obesity.
Keywords: ECG-LVH; Metabolically healthy obesity; NHANES-III.
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