Long-term metabolic fate and mortality in obesity without metabolic syndrome

Aki Juhani Käräjämäki; Arto Korkiakoski; Janne Hukkanen; Y Antero Kesäniemi; Olavi Ukkola

doi:10.1080/07853890.2022.2075915

Long-term metabolic fate and mortality in obesity without metabolic syndrome

Ann Med. 2022 Dec;54(1):1432-1443. doi: 10.1080/07853890.2022.2075915.

Authors

Aki Juhani Käräjämäki^{1

2}, Arto Korkiakoski^{2

3}, Janne Hukkanen², Y Antero Kesäniemi², Olavi Ukkola²

Affiliations

¹ Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland.
² Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
³ Department of Internal Medicine, Central Ostrobothnia Central Hospital, Kokkola, Finland.

Abstract

Background: Obesity and metabolic syndrome (MetS) are known to expose to atrial fibrillation (AF), cardiovascular diseases (CVD) and mortality. Metabolically healthy obesity refers to obesity without MetS. This study aimed to investigate how obesity and MetS modify the risk of CVD, AF and mortality in very long-time follow-up.

Methods: Finnish middle-aged subjects (n = 1045) were grouped into four subgroups according to the presence of obesity and MetS. CVD events and AF were followed for 24 years and total mortality for 30 years. Moreover, 600 available patients had a follow-up visit for metabolic examinations after approximately 22 years.

Results: One-hundred and sixty-two (30%) subjects without obesity or MetS died during the follow-up. Ninety-two (17%) of the patients in this group had a CVD event and 58 (11%) were diagnosed with AF. As compared to them, obese subjects without MetS had similar metabolic fate and mortality (mortality 26 (38%), p = .143; CVD event 12 (18%), p = .858 and AF 7 (10%), p = .912, respectively), whereas subjects with obesity and MetS had greater mortality (102 (49%), p < .001), more CVD (71 (34%), p < .001) and AF (49 (23%), p < .001). Non-obese individuals with MetS had greater rates of mortality (96 (44%), p < .001) and CVD (80 (37%), p < .001), but not of AF (26 (12%), p = .606). Of the 40 subjects with obesity but without MetS at baseline and available for the follow-up visit, 15 (38%) were metabolically healthy at the follow-up visit.

Conclusions: In the present long-term follow-up study, the presence of MetS, but not obesity only, implies a greater risk of mortality and CVD. The risk of AF is increased only in subjects with both obesity and MetS. However, obesity without MetS tends to progress eventually to obesity with MetS. Key messagesThe presence of metabolic syndrome (MetS), but not obesity only, entails a greater risk of mortality and cardiovascular diseases.The risk of atrial fibrillation is increased only in subjects with both obesity and MetS.Obesity without MetS tends to progress eventually to obesity with MetS.

Keywords: Metabolic syndrome; atrial fibrillation; cardiovascular disease; metabolically healthy obesity; mortality; obesity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Cardiovascular Diseases*
Finland / epidemiology
Follow-Up Studies
Humans
Metabolic Syndrome* / complications
Metabolic Syndrome* / diagnosis
Metabolic Syndrome* / epidemiology
Middle Aged
Obesity / complications
Risk Factors

Grants and funding

This work was supported by the Medical Foundation of Vaasa, Vaasa, Finland and the State Research Funding of Vaasa Hospital District.