Koros R, Domouzoglou EM, Papafaklis MI. Metabolically "healthy" obesity in postmenopausal women: Unmasking the cardiovascular risk. World J Cardiol 2025; 17(9): 110228 [DOI: 10.4330/wjc.v17.i9.110228]
Corresponding Author of This Article
Michail I Papafaklis, MD, PhD, Assistant Professor, Consultant, FESC, Cardiology Division, University Hospital of Patras, Leof. Ippokratous, Rio 26504, Achaia, Greece. m.papafaklis@yahoo.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Sep 26, 2025; 17(9): 110228 Published online Sep 26, 2025. doi: 10.4330/wjc.v17.i9.110228
Metabolically "healthy" obesity in postmenopausal women: Unmasking the cardiovascular risk
Rafail Koros, Eleni M Domouzoglou, Michail I Papafaklis
Rafail Koros, Michail I Papafaklis, Cardiology Division, University Hospital of Patras, Rio 26504, Achaia, Greece
Eleni M Domouzoglou, Pediatrics, Nafpaktos Health Center, Nafpaktos 30300, Etoloakarnania, Greece
Michail I Papafaklis, Faculty of Medicine, University of Patras, Rio 26504, Achaia, Greece
Author contributions: Koros R and Papafaklis M contributed to the conception, outline, and design of the manuscript; Koros R drafted the manuscript; Domouzoglou EM and Papafaklis MI critically revised and edited the manuscript for important intellectual content; All authors have approved the final version of the manuscript.
Supported by Program “MEDICUS” of the University of Patras, No. 82869, 3419/15.01.2024.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michail I Papafaklis, MD, PhD, Assistant Professor, Consultant, FESC, Cardiology Division, University Hospital of Patras, Leof. Ippokratous, Rio 26504, Achaia, Greece. m.papafaklis@yahoo.com
Received: June 3, 2025 Revised: July 8, 2025 Accepted: August 12, 2025 Published online: September 26, 2025 Processing time: 107 Days and 12.8 Hours
Abstract
The concept of metabolically healthy obesity (MHO) has attracted growing attention, but its clinical relevance and association with future cardiovascular risk remain unclear. Estrogen deficiency, which signifies the menopause phase, contributes to altered body composition and unfavorable metabolic processes. In this Editorial, we comment on the recent retrospective study by Pingili et al, which used a United States national in-patient population and observed significantly elevated odds of major adverse cardiac and cerebrovascular events in postmenopausal women with MHO compared with their age-matched non-obese counterparts. Of note, disproportionately greater risks were particularly observed among Black patients. These findings along with previous literature data call into question the seemingly benign profile of the MHO state. Obese individuals who appear metabolically healthy present an elevated cardiovascular risk which may be exacerbated in older female populations. These findings emphasize the need for vigilance and improved approaches of risk stratification which would translate into the early application of preventive measures.
Core Tip: Distinct metabolic health states exist among normal-weight and obese individuals and potentially translate into differences in future cardiovascular risk. Menopause is followed by critical metabolic changes, which are associated with a higher risk of metabolic and cardiovascular diseases. Postmenopausal women with a metabolically healthy obesity may represent a subgroup of individuals with exacerbated clinical risk despite a seemingly benign profile of metabolic parameters.
