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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Prevalence and impact of metabolically healthy obesity on cardiovascular outcomes in postmenopausal women and disparities: An age-matched study
Adhvithi Pingili, Rupak Desai, Roopeessh Vempati, Madhusha Vemula, Mohit Lakkimsetti, Hasmitha Madhavaram, Athmananda Nanjundappa, Sandeep Singh, Praveena Sunkara, Jyotsna Gummadi
Adhvithi Pingili, Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, United States
Rupak Desai, Department of Outcomes Research, Independent Researcher, Atlanta, GA 30079, United States
Roopeessh Vempati, Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, United States
Madhusha Vemula, Department of Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad 500055, Telangāna, India
Mohit Lakkimsetti, Department of Internal Medicine, Mamata Medical College, Khammam 507002, Telangāna, India
Hasmitha Madhavaram, Department of Internal Medicine, Morristown Medical Centre, Morristown, NJ 07960, United States
Athmananda Nanjundappa, Jyotsna Gummadi, Department of Medicine, Medstar Franklin Square Medical Center, Baltimore, MD 21237, United States
Sandeep Singh, Department of Internal Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Praveena Sunkara, Department of Internal Medicine, Passion Health Primary Care, Denton, TX 20622, United States
Co-first authors: Adhvithi Pingili and Rupak Desai.
Co-corresponding authors: Roopeessh Vempati and Praveena Sunkara.
Author contributions: Desai R and Pingili A. designed the research study and contributed equally as co-first authors; Vempati R, Vemula M, Lakkimsetti M, Madhavaram H, and Desai R performed the research; Pingili A, Desai R, Vempati R, Vemula M, Lakkimsetti M, Madhavaram H, and Sunkara P analyzed the data and wrote the manuscript; Nanjundappa A, Singh S, Pingili A, and Desai R reviewed and edited the manuscript; Vempati R and Sunkara P contributed equally as co-corresponding authors; All authors have read and approved the final manuscript.
Institutional review board statement: Since the data included in this article were de-identified and already available in publicly accessible databases, the IRB review was not mandatory. This article was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: No written consent has been obtained from the patients, as no patient-identifiable data from the National Inpatient Sample database is included in this observational study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data is available. All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Roopeessh Vempati, MD, Internal Medicine Resident, Department of Internal Medicine, Trinity Health Oakland Hospital, 44405 Woodward Avenue, Pontiac, MI 48341, United States.
roopeessh.vempati@gmail.com
Received: February 8, 2025
Revised: March 18, 2025
Accepted: March 31, 2025
Published online: April 26, 2025
Processing time: 72 Days and 10.6 Hours
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.
Core Tip: In our retrospective population-based cohort study using a national inpatient sample (2020), we analyzed the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes in hospitalized postmenopausal women. MHO was found to be associated with increased odds of major adverse cardiac and cerebrovascular events [adjusted odds ratio (aOR): 1.08, P = 0.028], particularly among black patients (aOR: 1.23, P = 0.035), and the lowest income quartile (aOR: 1.24, P = 0.007). Further, longitudinal studies are needed to assess the long-term cardiovascular risks in MHO patients.
