Overweight or obesity does not carry an increased risk of adverse outcome in young to middle age people without metabolic abnormalities

Objective: Overweight or obesity (OvOb) is a risk factor for the development of cardiometabolic complications. However, according to some investigators, OvOb developed without hypertension and insulin resistance may be considered as a benign phenotype. The aim of the present study was to investigate the prognostic significance of OvOb (BMI> = 25 kg/m 2 ) without concomitant metabolic abnormalities in young-to-middle-age subjects screened for stage 1 hypertension. Design and method: We examined 1208, 18-to-45-year-old participants from the HARVEST study. Mean age was 33.1 ± 8.6 years and BP 145.5 ± 10.6/93.5 ± 5.7 mmHg. Participants were classified into four groups according to whether they had OvOb or not (0/1) and had normal (group 0) or at least one abnormal (group 1) metabolic syndrome parameter (glucose, triglyceride, HDL-cholesterol, and average 24-hour BP). The predictive role of OvOb/metabolic group for incident hypertension and cardiovascular or renal events (MACE) was evaluated in Cox survival analyses, adjusting for other risk factors and several confounders. Results: ObOv was present in 51.1% of the participants and at least one metabolic abnormality was present in 74.5%. Among the subjects with OvOb, 20.2% had no metabolic abnormalities, 40.5% had one metabolic abnormality, and 39.3% had two or more metabolic abnormalities. During a median follow-up of 17.4 years, 80.6% of the participants developed hypertension requiring pharmacological treatment and 8.9% had a MACE. In adjusted Cox models, OvOb participants with at least one metabolic abnormality had an increased risk of incident hypertension (HR, 1.43; 95%CI,1.12 - 1.81, p = 0.003) and MACE (2.34,1.03 - 5.36, p = 0.043) compared to those with normal metabolic parameters. Among the participants with normal BMI, a similar metabolic-related increase in risk was found for the hypertension outcome (HR, 1.52;95%CI,1.21 - 1.92, p = 0.0003), but not for MACE (1.64,0.70 - 3.81, p = 0.25). In a Cox model in the whole population, when controlled for each other the metabolic group (0/1) was a predictor of hypertension (p < 0.0001) and MACE (p = 0.028) whereas the ObOv group was not (p>0.05). Conclusions: These data show that in young-to-middle-age people, an abnormal metabolic profile is an important predictor of future hypertension needing treatment and MACE. OvOb without metabolic abnormalities does not carry an increased risk of adverse outcomes.