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Effects of Metabolically Healthy and Unhealthy Obesity on Prolongation of Corrected QT Interval

Published:January 24, 2017DOI:https://doi.org/10.1016/j.amjcard.2016.12.033
      Although obesity and the metabolic syndrome (MS) often co-occur, many obese (OB) subjects have a favorable metabolic profile. It is unclear whether these factors independently influence cardiac electrophysiology including prolongation of the QT interval. We examined associations among obesity, MS, and prolonged corrected QT (QTc) interval in a large sample of Chinese research participants aged ≥35 years recruited from rural areas of Liaoning Province during 2012 to 2013. Of the 11,209 participants, 6,364 (56.8%) were nonobese and metabolically healthy (OB−/MS−), 2,853 (25.5%) were OB−/MS+, 493 (4.4%) were OB+/MS−, and 1,499 (13.4%) were OB+/MS+. Mean (±SD) QTc intervals were higher in OB−/MS+ (436.3 ± 24.3) and OB+/MS+ (436.6 ± 25.9) participants but not OB+/MS− participants (425.4 ± 24.0) than in OB−/MS− participants (426.8 ± 21.5, p <0.001), and the prevalence of QTc prolongation was higher in OB−/MS+ and OB+/MS+ participants (adjusted odds ratios [aOR] 1.68, 95% confidence interval [CI] 1.52 to 1.85; aOR 1.92, 95% CI 1.69 to 2.17, respectively) compared with OB−/MS− group but not in OB+/MS− participants (aOR 0.92, 95% CI 0.73 to 1.15). Prevalence increased with each MS component (aOR 1.27, 95% CI 1.22 to 1.32) but not with body mass index (aOR 1.01, 95% CI 0.99 to 1.02). In conclusion, prolonged QTc interval is associated with the MS and not independently associated with obesity.
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      References

        • Berrington de Gonzalez A.
        • Hartge P.
        • Cerhan J.R.
        • Flint A.J.
        • Hannan L.
        • MacInnis R.J.
        • Moore S.C.
        • Tobias G.S.
        • Anton-Culver H.
        • Freeman L.B.
        • Beeson W.L.
        • Clipp S.L.
        • English D.R.
        • Folsom A.R.
        • Freedman D.M.
        • Giles G.
        • Hakansson N.
        • Henderson K.D.
        • Hoffman-Bolton J.
        • Hoppin J.A.
        • Koenig K.L.
        • Lee I.M.
        • Linet M.S.
        • Park Y.
        • Pocobelli G.
        • Schatzkin A.
        • Sesso H.D.
        • Weiderpass E.
        • Willcox B.J.
        • Wolk A.
        • Zeleniuch-Jacquotte A.
        • Willett W.C.
        • Thun M.J.
        Body-mass index and mortality among 1.46 million white adults.
        N Engl J Med. 2010; 363: 2211-2219
        • Sundström J.
        • Risérus U.
        • Byberg L.
        • Zethelius B.
        • Lithell H.
        • Lind L.
        Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study.
        BMJ. 2006; 332: 878-882
        • Jung C.H.
        • Lee M.J.
        • Kang Y.M.
        • Hwang J.Y.
        • Kim E.H.
        • Park J.Y.
        • Kim H.K.
        • Lee W.J.
        The risk of chronic kidney disease in a metabolically healthy obese population.
        Kidney Int. 2015; 88: 843-850
        • Luo D.
        • Liu F.
        • Li X.
        • Yin D.
        • Lin Z.
        • Liu H.
        • Hou X.
        • Wang C.
        • Jia W.
        Comparison of the effect of ‘metabolically healthy but obese’ and ‘metabolically abnormal but not obese’ phenotypes on development of diabetes and cardiovascular disease in Chinese.
        Endocrine. 2015; 49: 130-138
        • Ogorodnikova A.D.
        • Kim M.
        • McGinn A.P.
        • Muntner P.
        • Khan U.
        • Wildman R.P.
        Incident cardiovascular disease events in metabolically benign obese individuals.
        Obesity. 2012; 20: 651-659
        • Sung K.C.
        • Ryu S.
        • Cheong E.S.
        • Kim B.S.
        • Kim B.J.
        • Kim Y.B.
        • Chung P.W.
        • Wild S.H.
        • Byrne C.D.
        All-cause and cardiovascular mortality among Koreans: effects of obesity and metabolic health.
        Am J Prev Med. 2015; 49: 62-71
        • Goldberg R.J.
        • Bengtson J.
        • Chen Z.Y.
        • Anderson K.M.
        • Locati E.
        • Levy D.
        Duration of the QT interval and total and cardiovascular mortality in healthy persons (The Framingham Heart Study experience).
        Am J Cardiol. 1991; 67: 55-58
        • Okin P.M.
        • Devereux R.B.
        • Howard B.V.
        • Fabsitz R.R.
        • Lee E.T.
        • Welty T.K.
        Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: the Strong Heart Study.
        Circulation. 2000; 101: 61-66
        • Grandinetti A.
        • Chow D.C.
        • Miyasaki M.
        • Low P.
        Association of increased QTc interval with the cardiometabolic syndrome.
        J Clin Hypertens (Greenwich). 2010; 12: 315-320
        • Faramawi M.F.
        • Wildman R.P.
        • Gustat J.
        • Rice J.
        • Abdul Kareem M.Y.
        The association of the metabolic syndrome with QTc interval in NHANES III.
        Eur J Epidemiol. 2008; 23: 459-465
        • Guo X.
        • Li Z.
        • Guo L.
        • Zheng L.
        • Yu S.
        • Yang H.
        • Zou L.
        • Zhou Y.
        • Zhang Y.
        • Zhu L.
        • Zhang Y.
        • Sun Y.
        An update on overweight and obesity in rural Northeast China: from lifestyle risk factors to cardiometabolic comorbidities.
        BMC Public Health. 2014; 14: 1046
        • Li Z.
        • Bai Y.
        • Guo X.
        • Zheng L.
        • Sun Y.
        • Roselle A.M.
        Alcohol consumption and cardiovascular diseases in rural China.
        Int J Cardiol. 2016; 215: 257-262
        • Bazett H.C.
        An analysis of the time relations of electrocardiograms.
        Heart. 1920; 7: 353-567
        • Steering Committee
        The Asia-Pacific Perspective: Redefining Obesity and Its Treatment.
        International Diabetes Institute, Melbourne2000: 11-12
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • Donato K.A.
        • Eckel R.H.
        • Franklin B.A.
        • Gordon D.J.
        • Krauss R.M.
        • Savage P.J.
        • Smith Jr., S.C.
        • Spertus J.A.
        • Costa F.
        • American Heart Association
        • National Heart, Lung, and Blood Institute
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
        • Schwartz P.J.
        • Moss A.J.
        • Vincent G.M.
        • Crampton R.S.
        Diagnostic criteria for the long QT syndrome. An update.
        Circulation. 1993; 88: 782-784
        • Li W.
        • Bai Y.
        • Sun K.
        • Xue H.
        • Wang Y.
        • Song X.
        • Fan X.
        • Song H.
        • Han Y.
        • Hui R.
        Patients with metabolic syndrome have prolonged corrected QT interval (QTc).
        Clin Cardiol. 2009; 32: E93-E99
        • Yang H.I.
        • Kim H.C.
        • Jeon J.Y.
        The association of resting heart rate with diabetes, hypertension, and metabolic syndrome in the Korean adult population: the Fifth Korea National Health and Nutrition Examination Survey.
        Clin Chim Acta. 2016; 455: 195-200
        • Jiang X.
        • Liu X.
        • Wu S.
        • Zhang G.Q.
        • Peng M.
        • Wu Y.
        • Zheng X.
        • Ruan C.
        • Zhang W.
        Metabolic syndrome is associated with and predicted by resting heart rate: a cross-sectional and longitudinal study.
        Heart. 2015; 101: 44-49
        • Karelis A.D.
        • Messier V.
        • Brochu M.
        • Rabasa-Lhoret R.
        Metabolically healthy but obese women: effect of an energy-restricted diet.
        Diabetologia. 2008; 51: 1752-1754
        • Ryu J.Y.
        • Lee J.S.
        • Hong H.C.
        • Choi H.Y.
        • Yoo H.J.
        • Seo J.A.
        • Kim S.G.
        • Kim N.H.
        • Baik S.H.
        • Choi D.S.
        • Choi K.M.
        Association between body size phenotype and sleep duration: Korean National Health and Nutrition Examination Survey V (KNHANES V).
        Metabolism. 2015; 64: 460-466
        • Camhi S.M.
        • Crouter S.E.
        • Hayman L.L.
        • Must A.
        • Lichtenstein A.H.
        Lifestyle behaviors in metabolically healthy and unhealthy overweight and obese women: a preliminary study.
        PLoS One. 2015; 10: e0138548
        • Phillips C.M.
        • Perry I.J.
        Depressive symptoms, anxiety and well-being among metabolic health obese subtypes.
        Psychoneuroendocrinology. 2015; 62: 47-53
        • Ortega F.B.
        • Lee D.C.
        • Katzmarzyk P.T.
        • Ruiz J.R.
        • Sui X.
        • Church T.S.
        • Blair S.N.
        The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness.
        Eur Heart J. 2013; 34: 389-397
        • Hinnouho G.M.
        • Czernichow S.
        • Dugravot A.
        • Nabi H.
        • Brunner E.J.
        • Kivimaki M.
        • Singh-Manoux A.
        Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: the Whitehall II cohort study.
        Eur Heart J. 2015; 36: 551-559
        • Dobson R.
        • Burgess M.I.
        • Sprung V.S.
        • Irwin A.
        • Hamer M.
        • Jones J.
        • Daousi C.
        • Adams V.
        • Kemp G.J.
        • Shojaee-Moradie F.
        • Umpleby M.
        • Cuthbertson D.J.
        Metabolically healthy and unhealthy obesity: differential effects on myocardial function according to metabolic syndrome, rather than obesity.
        Int J Obes. 2016; 40: 153-161
        • Cox A.J.
        • Azeem A.
        • Yeboah J.
        • Soliman E.Z.
        • Aggarwal S.R.
        • Bertoni A.G.
        • Carr J.J.
        • Freedman B.I.
        • Herrington D.M.
        • Bowden D.W.
        Heart rate-corrected QT interval is an independent predictor of all-cause and cardiovascular mortality in individuals with type 2 diabetes: the Diabetes Heart Study.
        Diabetes Care. 2014; 37: 1454-1461
        • Medenwald D.
        • Kluttig A.
        • Kors J.A.
        • Nuding S.
        • Tiller D.
        • Greiser K.H.
        • Werdan K.
        • Haerting J.
        QT interval, general mortality and the role of echocardiographic parameters of left ventricular hypertrophy: results from the prospective, population-based CARLA study.
        Eur J Prev Cardiol. 2016; 23: 428-436
        • Ziegler D.
        • Zentai C.P.
        • Perz S.
        • Rathmann W.
        • Haastert B.
        • Döring A.
        • Meisinger C.
        • KORA Study Group
        Prediction of mortality using measures of cardiac autonomic dysfunction in the diabetic and nondiabetic population: the MONICA/KORA Augsburg Cohort Study.
        Diabetes Care. 2008; 31: 556-561

      Linked Article

      • Prolongation of the QT Interval and Myocardial Ischemia Are More Pieces of the “Metabolically Unhealthy Obesity” Puzzle
        American Journal of CardiologyVol. 120Issue 5
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          The article by Guo et al1 sheds light on a scarcely studied aspect of the “metabolically healthy obesity” issue. In a large Chinese cohort, they found a significant association between the metabolic syndrome and prolongation of the QTc interval, independently of the presence of obesity. The authors comment that “as the debate (regarding metabolically healthy obesity) goes on, it may be useful to investigate potential mechanisms.” They discuss possible decreases in myocardial function, but do not comment on the well-recognized effects of myocardial ischemia on the QTc interval.
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