LAUSR

Objective: To the association between metabolically healthy overweight/obesity and the risk of sudden cardiac death in middle‐aged men. Participants and Methods: This prospective study was based on a population sample of 2185 men aged 42 to 60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study. Participants were divided into 4 groups on the basis of body mass index and metabolic health status. Metabolically healthy overweight/obesity was defined as body mass index 25 kg/m2 or greater without metabolic abnormalities, and metabolically unhealthy normal weight was defined as body mass index less than 25 kg/m2 with 1 or more metabolic abnormalities. Results: During a median follow‐up of 26 years (interquartile range, 18.7‐28.1 years), 240 sudden cardiac deaths (11%) occurred. Compared with metabolically healthy normal weight men, metabolically unhealthy overweight/obese men had a higher risk of sudden cardiac death (hazard ratio, 1.99; 95% CI, 1.03‐3.85) after adjusting for potential confounders. However, metabolically healthy overweight/obese men were not at increased risk of sudden cardiac death (hazard ratio, 0.95; 95% CI, 0.40‐2.24) as compared with their metabolically healthy normal weight counterparts after adjusting for age, smoking, low‐density lipoprotein cholesterol level, high‐sensitivity C‐reactive protein level, insulin level, history of myocardial infarction, and directly measured peak oxygen uptake. Conclusion: Our findings indicate that metabolically healthy normal weight men and metabolically healthy overweight/obese men were at comparable risk of sudden cardiac death over a 26‐year follow‐up period, suggesting that a baseline body mass index of 25 kg/m2 or greater per se does not adversely affect the risk of sudden cardiac death.