Association between the metabolically healthy obese phenotype and the risk of myocardial infarction: results from the Kailuan study

in European Journal of Endocrinology
Correspondence should be addressed to X Guo or Y Wang or S Wu; Email: or or

*(Y Xu and H Li contributed equally to this work)

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This study aimed to determine if the metabolically healthy obese (MHO) is associated with an increased risk of myocardial infarction (MI) in Chinese population.


The Kailuan study is a community-based prospective cohort study.


BMI and metabolic syndrome (MetS) were assessed in 91 866 participants without a history of MI or stroke. Participants were categorised into six mutually exclusive groups according to the BMI-MetS status: normal weight (BMI:  ≤ 18.5to < 24.0 kg/m2) without MetS (MH-NW), normal weight with MetS (MUH-NW), overweight (BMI:  ≤ 24.0to < 28.0 kg/m2) without MetS (MH-OW), overweight with MetS (MUH-OW), obese (BMI ≥ 28.0 kg/m2) without MetS (MHO) and obese with MetS (MUO). The hazard ratio (HR) with 95% CI was calculated for the incidence of MI using a multivariable Cox model.


A total of 6745 (7.34%) individuals were classified as MHO. During a median 8-year follow-up, 1167 (1.27%) participants developed MI. The MHO group had an increased risk of MI (HR: 1.76, 95% CI: 1.37–2.25) in comparison with the MH-NW group after adjusting for potential confounding variables. After a similar adjustment, the risk of MI was significantly elevated in the MUH-NW (HR: 1.62, 95% CI: 1.28–2.05), MUH-OW (HR: 1.98, 95% CI: 1.67–2.35) and MUO group (HR: 2.06, 95% CI: 1.70–2.49).


MHO subjects showed a substantially higher risk of MI in comparison with MH-NW subjects. That said, even without measurable metabolic abnormalities, obesity was associated with a higher risk of MI.

Downloadable materials

  • Supplementary Figure 1. The Flowchart of the Study Cohort
  • Supplemental materials for Association between Metabolically Healthy Obese Phenotype and Risk of Myocardial Infarction: Results from the Kailuan Study


     European Society of Endocrinology

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    Cumulative incidences of myocardial infarction (MI) according to the combined BMI category (normal weight, overweight, obese) and metabolic syndrome (absence or presence). A full colour version of this figure is available at


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