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Epidemiology and Population Health

Relationship between metabolic status, physical activity and cardiovascular disease in participants with obesity

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Objective

We aimed to investigate the independent and joint associations between metabolic status, PA (physical activity) and risk of CVD (cardiovascular disease) in participants with obesity.

Methods

We included 109,301 adults with obesity free of baseline CVD enrolled from 2006 to 2010 in the UK Biobank cohort (aged 56 ± 7.9 years). Based on metabolic status, obesity was grouped into metabolically healthy obesity (MHO; free of hypertension, hypercholesterolemia and diabetes; n = 26,989; BMI 33 ± 3.3 kg/m2) and metabolically unhealthy obesity (MUO; n = 82,312; BMI 34 ± 4.0 kg/m2). PA was categorized into four groups according to moderate-to-vigorous PA (MVPA): none, low, medium, and high. Multivariable Cox regression models were used for the main analyses adjusting for sociodemographic factors, lifestyles and comorbidities.

Results

There were 8,059 CVD events during a median follow-up of 8.1 years. MHO was associated with a 42% reduced risk of CVD compared with MUO (HR = 0.58, 95% CI: 0.53–0.63). A significant interaction effect between PA and metabolic status on CVD risk was found. Among MUO participants, individuals with PA had significantly decreased CVD risk when compared with no MVPA (HR = 0.87, 95% CI: 0.81–0.94 for low PA; HR = 0.85, 95% CI: 0.78–0.93 for medium PA; and HR = 0.86, 95% CI: 0.80–0.92 for high PA). The lowest CVD risk was observed in MHO & medium PA group when compared with MUO & no MVPA (HR = 0.45, 95% CI: 0.37–0.56).

Conclusions

Both MHO and any MVPA were associated with reduced risk of CVD in adults with obesity, while PA could modify the relationship between metabolic status and CVD risk.

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Data availability

The data can be available on application to the UK Biobank (www.ukbiobank.ac.uk/).

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Acknowledgements

This research has been conducted using the UK Biobank Resource under Application Number 63844. This research was supported by Science Foundation of Guangdong Second Provincial General Hospital (number: YY2018-002, recipient: GL).

Author information

Author notes

  1. These authors jointly supervised this work: Gregory Y. H. Lip, Guowei Li.

Authors and Affiliations

  1. Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China

    Yingxin Liu, Ruoting Wang, Jingyi Zhang & Guowei Li

  2. Vanke School of Public Health, Tsinghua University, Beijing, China

    Ai Zhao

  3. Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China

    Guiju Sun

  4. Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK

    Gregory Y. H. Lip

  5. Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gregory Y. H. Lip

  6. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Guowei Li

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Contributions

YL, AZ and GL participated in the design and conception of the study. YL and GL were responsible for data collection. YL performed the data analysis, table designs and all the authors contributed to the interpretation. YL and AZ drafted the manuscript and all the authors revised it critically and gave their approval of the final version. YL and AZ contributed equally to this work. GS, JZ, RW and GYHL provided professional support and made multiple revisions to the manuscript. GYHL and GL shared the joint senior authorship. GL is the study guarantor.

Corresponding author

Correspondence to Guowei Li.

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The authors declare no competing interests.

Ethical approval

The UK Biobank study was approved by the North West Multicenter Research Ethics Committee. All participants provided written consent before enrolment.

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Liu, Y., Zhao, A., Sun, G. et al. Relationship between metabolic status, physical activity and cardiovascular disease in participants with obesity. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01469-8

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