To evaluate whether multi-organ dysfunction trajectories for major adverse cardiovascular events (MACE) using clinically defined obesity classification improves risk discrimination compared with BMI-based categories, particularly in clinical settings.
Key Findings:
MACE risk increased from no dysfunction to persistent dysfunction under both obesity definitions, highlighting the importance of monitoring organ health.
Clinical obesity showed the highest risk for MACE compared to no obesity (aHR 2.03 for no dysfunction, aHR 1.61 for persistent dysfunction), indicating a need for targeted interventions.
Underweight individuals showed the highest risk under BMI categories, suggesting that BMI alone may misrepresent risk profiles.
10-year cumulative incidence of MACE was ~24% in clinical obesity with persistent dysfunction, underscoring the long-term risks associated with this condition.
Interpretation:
Multi-organ dysfunction trajectories are strongly associated with incident MACE, with clinically defined obesity providing better risk stratification than BMI-based categories, which could enhance clinical decision-making.
Limitations:
Study design is observational, limiting causal inferences.
Potential for residual confounding despite adjustments in analyses.
Findings may not be generalizable beyond the UK Biobank population, necessitating further research in diverse cohorts.
Conclusion:
Incorporating clinical obesity definitions with longitudinal dysfunction assessment may improve cardiovascular risk stratification, ultimately guiding better patient management.
