, Volume 63, Issue 3, pp 439–462 | Cite as

The long-term prognosis of heart diseases for different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies

  • Atieh Mirzababaei
  • Kurosh Djafarian
  • Hadis Mozafari
  • Sakineh Shab-BidarEmail author
Meta Analysis



This meta-analysis aimed to assess the association of different categories of weight and metabolic status with risk of heart diseases including myocardial infarction (MI), cardiovascular diseases (CVDs), and heart failure (HF).


Data from relevant studies were identified systematically by searching PubMed and Scopus search engines up to 29 May 2018. Prospective studies were included in the analyses with metabolically healthy normal weight (MHNW) as the reference. Pooled RRs and 95% CI were calculated using random-effects or fixed-effect models when appropriate. Subgroup analysis was applied to define possible sources of heterogeneity.


Overall, 21 studies (n = 778,401 participants) were eligible for the present meta-analysis. Generally, the risk of CVDs for all metabolic phenotypes in metabolically unhealthy obese increased compared with the MHNW group. A significant positive association between all metabolic phenotypes and the risk of HF was also observed expect for MHOW (RR = 1.10, 95% CI: 0.60–2.00, P = 0.76) and MHO phenotypes (RR = 0.96, 95% CI: 0.25–3.77, P = 0.95). Moreover, MUHO phenotype was associated with greater risk of MI compared with the MHNW phenotype (RR = 1.82, 95% CI: 1.50–2.22, P < 0.001, respectively).


Our findings showed that all metabolically unhealthy phenotypes in different categories of weight were associated with increased incident of CVDs/HF and MI. Furthermore, healthy overweight and obese subjects had increased risk of CVDs.


BMI Obesity Metabolic healthy Metabolic unhealthy Cardiovascular diseases Risk Myocardial infarction Heart failure 



Adult Treatment Panel III


body mass index


blood pressure


body fat


cardiovascular diseases


confidence intervals


Joint Committee for Developing Chinese Guidelines


Joint Interim Statement


fasting blood glucose


high-density lipoprotein cholesterol


hazard ratios


homeostatic model assessment-insulin resistance


high-sensitivity C-reactive protein


heart failure


intima-media thickness


insulin resistance


low-density lipoprotein cholesterol


International Diabetes Federation


myocardial infarction


metabolically healthy


metabolically healthy normal weight


metabolically healthy obese


metabolically healthy overweight


metabolically unhealthy


metabolically unhealthy normal weight


metabolically unhealthy obese


metabolically unhealthy overweight


meta-analysis of observational studies in epidemiology


metabolic syndrome


normal weight


Newcastle-Ottawa scale


odds ratios






relative risks


type 2 diabetes




triglyceride glucose


waist circumference


World Health Organization



This study was supported by the Student’s Scientific Research Center, Tehran, Iran.

Author contributions

A.M. and S.S.-B. contributed to the study concept and design; H.M. and A.B. designed search strategy and screened papers. A.B., S.S.-B. and K.D. performed statistical analysis; A.M. wrote the first draft of manuscript; all authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

12020_2019_1840_MOESM1_ESM.docx (913 kb)
Supplementary Figures


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Atieh Mirzababaei
    • 1
    • 2
  • Kurosh Djafarian
    • 3
  • Hadis Mozafari
    • 1
  • Sakineh Shab-Bidar
    • 1
    Email author
  1. 1.Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical Sciences (TUMS)TehranIran
  2. 2.Student’s Scientific Research Center, School of Nutritional Sciences and DieteticsTehran University of Medical Sciences (TUMS)TehranIran
  3. 3.Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical Sciences (TUMS)TehranIran

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