Cardiovascular outcomes in metabolically healthy Asian-American population with obesity (18–44 years): Insights from the National Inpatient Sample

Abstract

Objective

Obesity, often associated with cardiometabolic risk factors such as hypertension, diabetes, and hyperlipidemia, is a predictor of major adverse cardiac and cerebrovascular events (MACCE) in hospitalized patients. However, in-hospital outcomes among young, metabolically healthy (MHO) Asians with obesity have not been explored.

Methods

This was a retrospective cohort study that utilized 2019 National Inpatient Sample (NIS) database to identify hospitalizations of metabolically healthy young (18–44 years) Asian-Americans/Pacific Islanders (AA/API). Demographically matched cohorts of metabolically healthy Asians with obesity (MHO+) and Asians without obesity (MHO-) patients were compared for comorbidities and in-hospital outcomes using 1:1 propensity matching. Multivariable logistic regression analysis was conducted to identify predictors of MACCE in the MHO+ group.

Results

Among 327,065 young AA/API hospitalizations, 7.8 % (n=25,470) were obese. Of which, 14315 were metabolically healthy after excluding encounters with concomitant cardiometabolic risk factors. Matched cohorts (MHO+ and MHO-, N = 14,200, median age 32 years, >84 % female) showed that the MHO + group had higher rates of depression, anxiety, tobacco use disorder, chronic pulmonary disease, and hypothyroidism, while the MHO- group had higher cancer and cannabis use disorder rates. The odds of MACCE (aOR 0.98, 95%CI 0.70–1.37, p = 0.886), and the odds of all-cause mortality (aOR 1.26, 95CI% 0.4–3.99, p = 0.690) were not of statistical significance. Males (aOR 10.18, 95%Cl 3.39–30.53), drug users (aOR 2.87, 95%Cl 1.05–7.86), cancer patients (aOR 9.70, 95%Cl 2.14–44.01), and those with congenital circulatory anomalies (aOR 21.77, 95%Cl 4.07–116.60) had significantly higher odds of MACCE. Depression (aOR 3.09, 95%Cl 0.86–11.08), elective admission (aOR 3.71, 95%Cl 0.74–18.58), and tobacco use (aOR 0.81, 95%Cl 0.26–2.60) were not statistically significant predictors.

Conclusion

Asian Americans males, drug users and cancer patients face elevated cardiovascular risk despite having a lower BMI, while overall odds of in-hospital cardiovascular event rates were not statistically significant compared to metabolically healthy cohorts with obesity.