{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:44:48Z","timestamp":1790862288890,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,10,8]],"date-time":"2023-10-08T00:00:00Z","timestamp":1696723200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The association between metabolic syndrome and increased cardiovascular disease (CVD) risk is well\u2010established. However, in patients with incident CVD, the relationship between obesity, metabolic health, and subsequent CVD and mortality outcomes are less well\u2010established. This study investigated the association between body mass index (BMI), metabolic health and the risk of subsequent cardiovascular mortality and morbidity outcomes in patients with incident CVD events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cohort study identified 130\u00a0685 patients from the nationwide Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases in the United Kingdom. Patients were \u226518\u00a0years with incident CVD [coronary heart disease (CHD), stroke, or peripheral vascular disease (PVD)] between 1 January 1998 and 31 December 2017. BMI (in kg\/m<jats:sup>2<\/jats:sup>) was categorized as underweight (&lt;18.5), normal (18.5\u201324.9), overweight (25.0\u201329.9) and obese (\u226530). Within each BMI category, patients were grouped by increasing count of 1, 2 or 3 metabolic risk factors [RF] (dyslipidaemia, diabetes mellitus and hypertension) and were regarded as metabolically unhealthy while absence of these factors was considered metabolically healthy (MH). Multivariable Cox regression was used to assess the risk (hazard ratio with 95% confidence interval) of subsequent outcomes (non\u2010fatal CHD, stroke, PVD, incident heart failure, CVD\u2010mortality and all\u2010cause mortality) in BMI subgroups with incremental count of metabolic RFs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a median follow\u2010up of 13.0\u00a0years, a higher BMI was associated with reduced risk for stroke, PVD, CVD\u2010mortality and all\u2010cause mortality within each metabolic risk category, while increasing metabolic RFs within each BMI subgroup accounted for increasing risks. When compared with patients with normal BMI and no RF, CVD\u2010mortality risk in overweight patients with no RF was 0.76 (0.70\u20130.84), and in obese patients with no RF was 0.85 (0.76\u20130.96). The respective risk for all\u2010cause mortality in patients with overweight and no RF was 0.69 (0.65\u20130.72), and in obese patients with no RF was 0.75 (0.70\u20130.79). Subsequent outcomes of stroke and PVD showed similar trends. In contrast, the risk of subsequent non\u2010fatal CHD events and incident HF increased with higher BMI and with incremental metabolic risk factors within each BMI category. Underweight was constantly associated with increased risk for all outcomes regardless of the presence of metabolic RFs except for non\u2010fatal CHD events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with incident CVD, overweight and obesity were related to a more favourable prognosis for subsequent stroke, PVD and mortality (CVD\u2010related and all\u2010cause) irrespective of the presence of other metabolic risk factors.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.13340","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T23:39:11Z","timestamp":1697067551000},"page":"2653-2662","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population\u2010based cohort study"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4529-8237","authenticated-orcid":false,"given":"Ralph K.","family":"Akyea","sequence":"first","affiliation":[{"name":"Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Ntaios","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, School of Health Sciences University of Thessaly  Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Doehner","sequence":"additional","affiliation":[{"name":"Berlin Institute of Health at Charit\u00e9 \u2013 Center for Regenerative Therapies Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Deutsches Herzzentrum der Charite (Campus Virchow Klinikum) Charit\u00e9 Universit\u00e4tsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), partner site Berlin  Berlin Germany"},{"name":"Center for Stroke Research Berlin (CSB) Charit\u00e9 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66378-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.107.151092"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.09.032"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-014-9425-z"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"e_1_2_8_7_1","unstructured":"NHS Digital.Hospital Episode Statistics (HES). NHS Digit.2019.https:\/\/digital.nhs.uk\/data\u2010and\u2010information\/data\u2010tools\u2010and\u2010services\/data\u2010services\/hospital\u2010episode\u2010statistics(21 June 2019)"},{"key":"e_1_2_8_8_1","unstructured":"Office for National Statistics.Deaths Registration Data. ONS.2018.https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths(21 June 2019)."},{"key":"e_1_2_8_9_1","unstructured":"Department of Communities and Local Government.English Indices of Deprivation 2015.2015. p. 1\u201311.https:\/\/www.gov.uk\/government\/statistics\/english\u2010indices\u2010of\u2010deprivation\u20102015(10 July 2016)."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdt116"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1068\/a37168"},{"key":"e_1_2_8_12_1","unstructured":"World Health Organization (WHO) Europe.Body mass index \u2010 BMI.https:\/\/www.euro.who.int\/en\/health\u2010topics\/disease\u2010prevention\/nutrition\/a\u2010healthy\u2010lifestyle\/body\u2010mass\u2010index\u2010bmi(24 March 2021)"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.07.763"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(19)30012-3"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12818"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.593434"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2011.04.010"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2011.09.039"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa293"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci17-0010"},{"key":"e_1_2_8_21_1","first-page":"145","article-title":"Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes","volume":"369","author":"The Look AHEAD Research Group","year":"2013","journal-title":"Massachusetts Med Soc"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.07.008"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2032183"},{"key":"e_1_2_8_24_1","first-page":"103","article-title":"Developing Quality and Outcomes Framework (QOF) indicators and the concept of \u2018QOFability\u2019","volume":"18","author":"Lester H","year":"2010","journal-title":"Qual Prim Care"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12899"}],"container-title":["Journal of Cachexia, Sarcopenia and Muscle"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcsm.13340","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T05:07:26Z","timestamp":1704949646000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jcsm.13340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,8]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1002\/jcsm.13340"],"URL":"https:\/\/doi.org\/10.1002\/jcsm.13340","archive":["Portico"],"relation":{},"ISSN":["2190-5991","2190-6009"],"issn-type":[{"value":"2190-5991","type":"print"},{"value":"2190-6009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,8]]},"assertion":[{"value":"2023-05-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}