Prevalence and impact of metabolically healthy obesity on cardiovascular outcomes in postmenopausal women and disparities: An age-matched study.

Abstract

Background: There is widespread debate about the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes. However, studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmenopausal population.

Aim: To explore the prevalence of MHO and its relationship with hospitalization outcomes, including major adverse cardiac or cerebrovascular events (MACCE), in postmenopausal women.

Methods: We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease, Tenth Revision, Clinical Modification codes for all admissions of postmenopausal women. We excluded patients with diabetes, hypertension, and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts. We used a 1:1 propensity score matching method to match patients with and without MHO based on age, and then we did a multivariable regression analysis for in-hospital MACCE.

Results: In 2020, 1304185 metabolically healthy postmenopausal women were admitted; 148250 (11.4%) had MHO. After propensity score matching for age, a statistically significant difference was observed in overall MACCE [odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.16, P = 0.028] among MHO and non-MHO cohorts, especially in patients of African-American ethnicity (OR: 1.23, 95%CI: 1.01-1.49, P = 0.035) and the lowermost income quartile (OR: 1.24, 95%CI: 1.06-1.44, P = 0.007).

Conclusion: Postmenopausal patients with MHO are at risk of MACCE, especially black patients and those with lower incomes. Larger prospective studies can demystify MHO's impact on cardiovascular outcomes among postmenopausal women.