Research Paper Volume 13, Issue 11 pp 15114—15125

Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort

Anxin Wang1,2, *, , Yu Wang1,2, *, , Yingting Zuo3,4, , Xue Tian3,4, , Shuohua Chen5, , Yihan Ma5,6, , Xu Han5,6, , Shouling Wu5, , Xingquan Zhao1,2,7, ,

  • 1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • 3 Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
  • 4 Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
  • 5 Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
  • 6 Graduate School of North China University of Science and Technology, Tangshan, China
  • 7 Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
* Equal contribution

Received: October 30, 2020       Accepted: March 23, 2021       Published: June 3, 2021
How to Cite

Copyright: © 2021 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


We aim to investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population. 37,180 participants with at least one-time measurement of branchial-ankle pulse wave velocity (baPWV) were included in the cross-sectional analysis, and 16,236 participants with repeated measurement of baPWV during the follow-ups were included in the longitudinal study. Cross-classification of body mass index (BMI) categories and metabolic health status created six groups. Linear and logistic regression analyses were used. The results of cross-sectional and longitudinal investigation were essentially the same, as the abnormality of baPWV increased with BMI categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants. A 1.4-fold, 2.2-fold increased risk for the new occurrence of arterial stiffness were documented in MHO and metabolically unhealthy obese participants compared to metabolically healthy normal-weight controls in the fully adjusted model. Further stratified analysis showed that metabolic health status was an interaction factor between BMI and arterial stiffness in all study populations (P=0.0001 for cross-sectional study and P=0.0238 for longitudinal study). In conclusion, metabolic health status and BMI categories contribute to the progression of arterial stiffness, while BMI is positively associated with arterial stiffness only in metabolically healthy participants.


baPWV: branchial-ankle pulse wave velocity; BMI: body mass index; BP: blood pressure; CI: confidence interval; CVD: cardiovascular disease; IDF: International Diabetes Federation; IPW: Inverse probability weighting; MetS: metabolic syndrome; MH-NW: metabolically healthy normal weight; MH-OW: metabolically healthy overweight; MHO: metabolically healthy obese; MUH-NW: metabolically unhealthy normal weight; MUH-OW: metabolically unhealthy overweight; MUO: metabolically unhealthy obese; OR: odds ratio; WC: waist circumference.