Transitions in Metabolic Health and Associations With Arterial Stiffness Progression Across Body Mass Index Categories

Metabolically healthy obesity is an unstable state and its transition to a metabolically unhealthy phenotype confers an increased risk of cardiovascular disease. However, it remains unclear whether changes in metabolic health over time are associated with arterial stiffness progression, a key player in the pathophysiology of cardiovascular disease. We aimed to investigate the associations of changes in metabolic health across body mass index categories with arterial stiffness and its progression. This study included 22 153 participants without cardiovascular disease or cancer at baseline from the Kailuan Study. Arterial stiffness was assessed using brachial-ankle pulse wave velocity at baseline and repeated after a mean follow-up of 3.1 years. Changes in metabolic health across body mass index categories were evaluated between the first survey (2006–2007) and the first brachial-ankle pulse wave velocity measurement. Multivariate linear regression models were used. Among initial metabolically healthy obese individuals, 53.4% (n=928) converted to a metabolically unhealthy phenotype. Compared with metabolically healthy normal-weight individuals who remained metabolically healthy, metabolically healthy obese individuals who converted to a metabolically unhealthy phenotype showed a 110.7 (95% CI, 90.8–130.6) cm/s higher increase in baseline brachial-ankle pulse wave velocity and a 22.8 (95% CI, 12.4–33.2) cm/s per year higher acceleration in arterial stiffness progression. Individuals who were initially metabolically unhealthy or converted so during follow-up across body mass index categories had higher baseline brachial-ankle pulse wave velocity and arterial stiffness progression than those who remained metabolically healthy. These data suggest that metabolically healthy individuals who develop an unhealthy phenotype across all body mass index categories are at increased risks of arterial stiffness and its progression.