Obesity and Subtypes of Incident Cardiovascular Disease

Author:

Ndumele Chiadi E.12,Matsushita Kunihiro2,Lazo Mariana32,Bello Natalie4,Blumenthal Roger S.1,Gerstenblith Gary1,Nambi Vijay56,Ballantyne Christie M.6,Solomon Scott D.7,Selvin Elizabeth2,Folsom Aaron R.8,Coresh Josef2

Affiliation:

1. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD

2. Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

3. Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

4. Division of Cardiology, Columbia University Medical Center, New York, NY

5. Michael E DeBakey Veterans Affairs Hospital, Houston, TX

6. Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX

7. Division of Cardiology, Brigham and Womens’ Hospital, Boston, MA

8. Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN

Abstract

Background Obesity is a risk factor for various subtypes of cardiovascular disease ( CVD ), including coronary heart disease ( CHD ), heart failure ( HF ), and stroke. Nevertheless, there are limited comparisons of the associations of obesity with each of these CVD subtypes, particularly regarding the extent to which they are unexplained by traditional CVD mediators. Methods and Results We followed 13 730 participants in the Atherosclerosis Risk in Communities (ARIC) study who had a body mass index ≥18.5 and no CVD at baseline (visit 1, 1987–1989). We compared the association of higher body mass index with incident HF , CHD , and stroke before and after adjusting for traditional CVD mediators (including systolic blood pressure, diabetes mellitus, and lipid measures). Over a median follow‐up of 23 years, there were 2235 HF events, 1653 CHD events, and 986 strokes. After adjustment for demographics, smoking, physical activity, and alcohol intake, higher body mass index had the strongest association with incident HF among CVD subtypes, with hazard ratios for severe obesity (body mass index ≥35 versus normal weight) of 3.74 (95% CI 3.24–4.31) for HF , 2.00 (95% CI 1.67–2.40) for CHD , and 1.75 (95% CI 1.40–2.20) for stroke ( P <0.0001 for comparisons of HF versus CHD or stroke). Further adjustment for traditional mediators fully explained the association of higher body mass index with CHD and stroke but not with HF (hazard ratio 2.27, 95% CI 1.94–2.64). Conclusions The link between obesity and HF was stronger than those for other CVD subtypes and was uniquely unexplained by traditional risk factors. Weight management is likely critical for optimal HF prevention, and nontraditional pathways linking obesity to HF need to be elucidated.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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