Abstract 16787: Impact of Metabolic Healthy Obesity on Cardiovascular Outcomes of Hospitalized Postmenopausal Women (Age>55 Years) and Associated Disparities: A Population-Based Analysis

Introduction: Metabolically healthy obesity's (MHO) impact on cardiovascular outcomes is debated. However, MHO's impact on cardiovascular outcomes in postmenopausal women is unexplored. Our study explored MHO's prevalence and correlation with in-hospital major adverse cardiac and cerebrovascular events (MACCE) in postmenopausal women.

Methods: Data was analyzed from National Inpatient Sample 2020 for admissions of postmenopausal women (>age 55 years) with and without obesity. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software. After propensity score matching (PSM) patients with MHO and non-MHO for age, we performed a multivariable regression analysis for in-hospital MACCE. Also, using tests of model effects, we determined predictors of MACCE in postmenopausal women with MHO.

Results: In 2020, 1304185 metabolically healthy postmenopausal women over age 55 years were admitted; 1155935 (88.6%) had no MHO, and 148250 (11.4%) had MHO. However, after PSM for age, there were 148250 in each cohort. In MHO cohort, median age was 65 years, 78.6% were white, 8.1% were African-American, and 28.2% were from lowermost income quartile. Most common comorbidities in MHO cohort were chronic pulmonary disease (29.2%), hypothyroidism (20.7%), and tobacco use disorder (23.9%). We observed a statistically significant difference in overall MACCE [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01-1.16, p=0.028] among MHO and non-MHO cohorts, especially in patients from African-American ethnicity (OR 1.23, 95% CI 1.01-1.49, p=0.035) and lowermost income quartile (OR 1.24, 95% CI 1.06-1.44, p= 0.007). However, no significant all-cause mortality was observed (OR 1.02, 95% CI 0.94-1.12, p=0.621). Several predictors of MACCE in postmenopausal women with MHO were observed, with non-elective admission being the strongest (OR 7.38, 95% CI 5.91-9.22, p<0.001).

Conclusion: This large population-based analysis revealed that postmenopausal patients with MHO are at risk of MACCE, particularly those from African-American ethnicity and lowermost income quartile. Larger prospective studies are needed to "demystify" the controversial MHO in cardiovascular diseases.