Are Metabolically Healthy Overweight/Obese Men at Increased Risk of Sudden Cardiac Death?

Objective: To the association between metabolically healthy overweight/obesity and the risk of sudden cardiac death in middle-aged men. Participants and Methods: This prospective study was based on a population sample of 2185 men aged 42 to 60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study. Participants were divided into 4 groups on the basis of body mass index and metabolic health status. Metabolically healthy overweight/obesity was defined as body mass index 25 kg/m ² or greater without metabolic abnormalities, and metabolically unhealthy normal weight was defined as body mass index less than 25 kg/m ² with 1 or more metabolic abnormalities. Results: During a median follow-up of 26 years (interquartile range, 18.7-28.1 years), 240 sudden cardiac deaths (11%) occurred. Compared with metabolically healthy normal weight men, metabolically unhealthy overweight/obese men had a higher risk of sudden cardiac death (hazard ratio, 1.99; 95% CI, 1.03-3.85) after adjusting for potential confounders. However, metabolically healthy overweight/obese men were not at increased risk of sudden cardiac death (hazard ratio, 0.95; 95% CI, 0.40-2.24) as compared with their metabolically healthy normal weight counterparts after adjusting for age, smoking, low-density lipoprotein cholesterol level, high-sensitivity C-reactive protein level, insulin level, history of myocardial infarction, and directly measured peak oxygen uptake. Conclusion: Our findings indicate that metabolically healthy normal weight men and metabolically healthy overweight/obese men were at comparable risk of sudden cardiac death over a 26-year follow-up period, suggesting that a baseline body mass index of 25 kg/m ² or greater per se does not adversely affect the risk of sudden cardiac death.