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CVD onset occurs earlier in people with higher BMI
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Adults with overweight or obesity were diagnosed with CVD at a younger age and lived longer with the disease compared with those with normal BMI, according to results presented at the American Heart Association’s Epidemiology and Prevention/Lifestyle and Cardiometabolic Health Scientific Sessions.
“Participants with a BMI 25 kg/m2 had a greater lifetime risk of [CVD] and lived a greater proportion of life with [CVD],” Sadiya Khan, MD, MSc, an instructor of medicine at Northwestern University Feinberg School of Medicine, told Cardiology Today. “Further, by implementing the life course approach in participants free of [CVD] at baseline, we were able to demonstrate earlier onset of [CVD].”
Researchers analyzed data from 170,205 participants, of whom 72,490 were aged 40 to 59 years (middle-aged group). Participants did not have CVD at baseline, and the mean baseline BMI for middle-aged men was 27.4 kg/m2 (standard deviation, 4.1) vs. 27.1 kg/m2 (standard deviation, 6) for middle-aged women, according to an abstract.
Upon follow-up (1.3 million person-years) for the middle-aged group, there were 13,457 CVD events reported, which included CHD, HF, stroke and death (n = 6,309), and 11,782 non-CVD deaths.
In the middle-aged group, lifetime risk for CVD increased among participants with obesity (BMI 30 kg/m2) or overweight (BMI, 25-29.9 kg/m2) compared with those with normal BMI. Participants who were middle-aged with normal BMI lived longer without CVD vs. those with obesity or overweight, who lived longer with CVD.
Among middle-aged men, compared with those with normal BMI, the competing HR for incident CVD was 1.21 (95% CI, 1.14-1.28) for those with a BMI of 25 kg/m2 to 29.9 kg/m2, 1.67 (95% CI, 1.55-1.79) for those with a BMI of 30 kg/m2 to 39.9 kg/m2 and 3.14 (95% CI, 2.48-3.97) for those with a BMI 40 kg/m2.
Among middle-aged women, compared with those with normal BMI, those with a BMI of 25 kg/m2 to 29.9 kg/m2 had a competing HR for CVD of 1.32 (95% CI, 1.24-1.4). For those with a BMI of 30 kg/m2 to 39.9 kg/m2, the competing HR for CVD was 1.85 (95% CI, 1.72-1.99), and for those with a BMI 40 kg/m2, it was 2.53 (95% CI, 2.2-2.91).
Researchers observed comparable patterns in participants of younger and older ages.
The researchers concluded the data suggest the “obesity/overweight paradox” exists because of sooner onset of CVD.
“One important difference is that our study included participants free of [CVD] at baseline,” Khan told Cardiology Today. “Further, our data suggest that the overweight and the obesity paradox may simply reflect earlier onset of the disease and greater number of years lived with [CVD].” – by Darlene Dobkowski
Reference:Khan S, et al. Presentation 9. Presented at American Heart Association’s Epidemiology and Prevention/Lifestyle and Cardiometabolic Health 2017 Scientific Sessions; March 7–10, 2017; Portland, Ore.
Disclosure : Khan reports no relevant financial disclosures.
Perspective
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Robert H. Eckel, MD
The findings of this abstract add to the knowledge base that overweight and obese men and women have more incident CVD. Based on that group, they live less longer than normal weight men and women, but life after a CVD event is a bit longer than for normal weight people.
For clinical practice, let’s learn more about what factors best predict earlier CVD events in overweight and obese people and be more aggressive in modifying them.
The “obesity paradox” label is misleading. Yes, the data after a CVD event indicate a paradox, but having an event and reduced lifespan are still important issues. Now why?
Perhaps once a CVD event occurs, overweight and obese patients are possibly more aggressively treated.
People who are overweight or obese can reduce their risk for CVD if they change their diet, but the question is, which diet? I suggest that the emphasis is quality first, ie, DASH or Mediterranean-style (Eckel RH, et al. Circulation. 2013;doi: 10.1161/01.cir.0000437740.48606.d1), and then quantity in regards to weight loss.
The additional research I would like to see done in this area is to obtain information related to CVD risk and management of this risk after a CVD event.
Let’s prevent CVD events and related loss of lifespan in everyone. The emphasis shouldn’t be placed only on the so-called “paradox,” although it is interesting.
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