Single excess weight measurement ‘does not seal one’s fate’ for heart-related events
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Key takeaways:
- A single overweight BMI measurement was not associated with CVD risk over time.
- Exposure to excess BMI over 10 years was associated with increased CVD risk for younger but not older adults.
BOSTON — Younger adults are at greater cardiovascular disease risk if they have obesity for 10 years, but a single excess weight measurement does not predict risk for heart-related events over time, according to data presented at ENDO 2024.
The findings, from an analysis of more than 136,000 health care professionals that began in 1990, highlight the importance of treating people with obesity as early in the disease course as possible to improve the CV risk profile, according to Alexander Turchin, MD, MS, associate professor of medicine at Harvard Medical School and director of quality in the division of endocrinology at Brigham and Women’s Hospital.
“Excess weight at a given point in time does not seal one’s fate,” Turchin told Healio. “What has a greater impact is what is done about it next, over time.”
Researchers analyzed data prospectively collected from 136,498 adults who participated in the Nurses’ Health Study and the Health Professionals Follow-Up Study, all of whom had a BMI in the overweight or obese range of more than 25 kg/m2 at least once from 1990 to 1999. The mean baseline age of participants was 49 years; 80% of participants were women; the mean baseline BMI was 27.2 kg/m2. The researchers calculated annualized cumulative excess BMI exposures greater than 25 kg/m2 from 1990 to 1999 and assessed the incidence of CV events (myocardial infarction, stroke or CV death) from 2000 to 2020.
Within the cohort, 51% had atherosclerotic CVD; 2.6% had type 2 diabetes and 47.7% had a history of smoking.
At follow-up in 2020, there were 12,048 CV events.
Researchers found that an elevated baseline BMI measurement was not associated with an increased CV risk in any age or sex subgroup. However, having annualized cumulative excess BMI in the fourth vs. the first quartile was associated with increased CV risk for women younger than 35 years in 1990 (HR = 1.6; 95% CI, 1.05-2.44), for women aged 35 to 50 years at baseline (HR = 1.27; 95% CI, 1.01-1.58), for men aged 35 to 50 years at baseline (HR = 1.57; 95% CI, 1.22-2.03) and men aged 50 to 65 years at baseline (HR = 1.23; 95% CI, 1.02-1.48).
There was no difference in CV risk between the fourth vs. first quartiles of excess BMI exposure for women older than 50 years and men older than 65 years.
“Treatment of obesity should not be delayed — particularly in younger patients,” Turchin told Healio. “Timely treatment could make a big difference in clinical outcomes.”
During a Q&A session after a press conference on the findings, Turchin said it remains unclear why the greater CV risk was seen in younger vs. older adults.
“The short answer is we don’t know,” Turchin told Healio. “Going into [the study], I would have expected it would be the other way around, because generally there is greater risk for heart attack and stroke [among older adults]. This is something we need to look into further. Having said this, other literature looking at longitudinal exposure to weight for other outcomes, such as cancer and diabetes, found similar effects, with greater [risk for] younger patients.”
Perspective
Back to TopThere is an inherent problem with this study as it uses BMI. Though BMI is the current standard used to mainly quantify weight management, it is a problematic metric. This is due to how it translates to quality of life and health, especially across body types (muscular, etc), as well as demographics.
The other issue is that the study had four times more women than men, which gives me concern about the generalizability of the study. There must be more equal distribution of men vs. women for this data to be more useful, and the use of parameters other than BMI, such as waist circumference or body composition, would give us more answers about clinical implications.
We need to learn more about the use of more viable measurements of quality of life ascertainment, such as body composition and waist circumference, when defining the generalizability of studies such as this.
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Turchin A, et al. OR33-01. Presented at: ENDO annual meeting; June 1-4, 2024; Boston.
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