Association of Anthropometric Indices With Midlife Cardiovascular Risk in Young Individuals Without Obesity and Traditional Risk Factors

Abstract

Background The aim of this study was to assess how early‐adulthood body mass index (BMI) and waist circumference (WC) relate to long‐term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden. Methods and Results A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF‐optimal subgroup was also defined, with blood pressure<120/80 mm Hg, fasting glucose <100 mg/dL, total cholesterol <200, low‐density lipoprotein cholesterol <130, and women with high‐density lipoprotein cholesterol ≥50 mg/dL. Coronary artery calcification, carotid intima‐media thickness, left ventricular mass, left ventricular ejection fraction, longitudinal peak systolic strain, and diastolic function were assessed in midlife. Cox regression was used to calculate hazard ratios of BMI and WC for all‐cause death and CVD events. Logistic regression was used to estimate odds ratios for subclinical CVD. Over 33.9 years (median follow‐up), 5.2% (n=105) died, and 2.6% (n=52) had CVD events. Each 1‐SD BMI increase was associated with 27% (95% CI, 1.10–1.47), 24% (1.08–1.43), 42% (1.20–1.68), 28% (1.05–1.57), 51% (1.20–1.90), and 49% (1.10–2.02) higher odds of coronary artery calcification presence, increased carotid intima‐media thickness, left ventricular hypertrophy, reduced left ventricular ejection fraction, low longitudinal peak systolic strain, and diastolic dysfunction, respectively, in the CVRF‐low group. Generally, similar associations were found for WC and in the CVRF‐optimal subgroup. No significant associations between BMI and WC with CVD and death were found. Conclusions Elevations in BMI and WC among young low‐risk individuals, even within the nonobesity range, are associated with midlife cardiovascular health.