IJCS | Volume 33, Nº1, January / February 2019

56 prevalence of obesity, ranging from 8% to 40%. 5 Ortega et al. 5 proposed a universal classification of MHO, which should be diagnosed by the absence of all diagnostic elements of the metabolic syndrome (MS) proposed by the International Diabetes Federation, except for abdominal circumference, as follows – blood pressure ≥ 130/85 mmHg (or antihypertensive drug treatment), HDL-cholesterol < 40 mg/dL (or drug treatment for this condition), triglycerides > 150 mg/dl (dL (or drug treatment for this) and fasting glucose ≥ 100 mg/dl (or treatment for this condition). 5 The most correct study in terms of methodology, that evaluated the relationship between MHO and atherosclerosis by coronary computed tomography angiography, was the study by Chang et al. 6 The authors concluded that MHO individuals had a higher prevalence of coronary calcification than normal weight individuals. However, such association was no longer statistically significant after adjustment of the values for themetabolic risk factors. This fact suggests that, inMHO subjects, this association occurred at higher (but still normal) levels. One limitation of this study is that it was conducted with a relatively young (mean age of 39.8 years), homogenous population of Asian patients, making the extrapolation of results to other populations difficult. 6 Previous studies that did not show an association between MHO, CAD and cardiovascular risk had methodological limitations, such as the presence of one of the MS diagnostic criteria (in addition of abdominal circumference); the authors did not detect new-onset metabolic changes in MHO individuals after inclusion in the study; and control groups were composed of overweight subjects rather than metabolically healthy or normal weight individuals. 6 Another important consideration is that MHO is not a stable condition, and hence should not be considered as a reliable clinical parameter for predicting cardiovascular risk. Mongraw-Chaffin et al. 7 followed 6,809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) for approximately 12 years. The authors concluded that although MHO individuals had a low risk of developing cardiovascular diseases in the beginning of the study, at least 50% of them developed the metabolically unhealthy obesity (MUO). The presence and duration of MUO was stronglyassociatedwith thedevelopment of cardiovascular disease and increased mortality. 7 A large cohort study, 8 evaluating individuals with MHO, concluded that weight lost, particularly greater than 5% of body weight was associated with lower incidence of atherosclerosis, assessed using carotid artery ultrasonography. 8 The prevalence of obesity has increased in the last three decades, reaching epidemic proportions in the world. In Brazil, recent data from VIGITEL, a surveillance system for risk factors for chronic diseases by telephone survey, showed that 56% of Brazilians were overweight and 20% were obese in 2018. 9 Although it has not been precisely defined whether obesity is an independent risk factor or simply a risk marker, its associationwith atherosclerosis, and total and cardiovascular mortality is unquestionable. MHO should not be considered a benign or stable condition, since it frequently progresses to MS, which has been proven to increase cardiovascular risk. In conclusion, obesity must be prevented and treated since childhood. 1. Pereira LLS, Moraes GM, Castro Carneiro AC, Moreira V, Bello JH, Prazeres CE, et al. Relationship between Obesity and Coronary Artery Disease Defined by Coronary Computed Tomography Angiography. Int J Cardiovasc Sci. 2020;33(1):57-64. 2. Lovren F, Teoh H, Subodh V. Obesity and Atherosclerosis: Mechanistic Insights. Can J Cardiol. 2015; 31(2):177-83. 3. Dippe Jr. T, Cunha CLP, Cerci RJ, Stier Jr AL, Vitola JV, et al. Study of Myocardial Perfusion in Obese Individuals without Known Ischemic Heart Disease. Arq Bras Cardiol. 2019; 11S, et al.2(2)a:121-8. 4. Mandviwala T, KhalidU, DeswalA. Obesity and Cardiovascular Disease: a Risk Factor or a Risk Marker.Curr Atheroscler Rep. 2016;18(5):21. 5. Ortega FB, Lavie CJ, Blair S N. Obesity and Cardiovascular Disease. Circulation Research. 2016;118(11):1752–70. 6. Chang Y, KimBK, Yun KE, Cho J, Zhang Y, Rampal S, et al. Metabolically healthy obesity and coronary artery calcification. JAmColl Cardiol. 2014; 63(24):2679-86. 7. Mongraw-Chaffin M, Foster MC, Anderson CAM, Burke GL, Haq N, Kalyani R. et al. Metabolically Healthy Obesity, Transition to Metabolic Syndrome andCardiocascular Risk. JAmColl Cardiol. 2018;71(17):1857-65. 8. Sinn DH, Kang D, Cho SJ,Chang Y, Ryu S, Song YB. et al. Weight Change and Development of Subclinical CarotidAtherosclerosisAmong Metabolically HealthyAdults: ACohort Study. J Clin Endocrinol Metab. 2019;104(11):145-63. 9. Brasil.Ministério da Saúde.Vigitel Brasil 2018. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. .[Internet] [Citado em 2019 jul 30]. Disponível em: portalarquivos2.saude.gov.br/ images/pdf/2019/julho/25/vigitel-brasil-2018.pdf References Dippe Júnior & Cerci Obesity and atherosclerosis Int J Cardiovasc Sci. 2020;33(1):55-56 Editorial This is an open-access article distributed under the terms of the Creative Commons Attribution License