A long term cohort study in the US revealed that obesity remains a risk factor for cardiovascular disease (CVD), even when metabolic health is maintained during long periods of time. A large proportion of metabolically healthy women converted to an unhealthy phenotype over time across all BMI categories, which is associated with an increased CVD risk. The study included 90 257 women with a median follow-up of 24 years. CVD risk of women with metabolically healthy obesity (defined by absence of diabetes, hypertension and hypercholesterolaemia) was increased compared with women with metabolically healthy normal weight (HR 1·39), but risk was considerably higher in women with metabolically unhealthy normal weight (2·43), overweight (2·61) and obesity (3·15). The majority of metabolically healthy women converted to unhealthy phenotypes (84% and 68%, respectively， for women with obesity or normal-weight after 20 years). Women who maintained metabolically healthy obesity during follow-up were still at a higher CVD risk compared with women with stable healthy normal weight (HR 1·57), yet this risk was lower than for initially metabolically healthy women who converted to an unhealthy phenotype (normal-weight 1·90 vs obesity 2·74). Particularly incident diabetes and hypertension increased the risk among women with initial metabolic health. Source: https://www.thelancet.com/
