Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity

Sadiya Sana Khan*, Hongyan Ning, John T Wilkins, Norrina Bai Allen, Mercedes R Carnethon, Jarett D. Berry, Ranya Nabil Sweis, Donald M Lloyd-Jones

*Corresponding author for this work

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

IMPORTANCE Prior studies have demonstrated lower all-cause mortality in individuals who are overweight compared with those with normal body mass index (BMI), but whether this may come at the cost of greater burden of cardiovascular disease (CVD) is unknown. OBJECTIVE To calculate lifetime risk estimates of incident CVD and subtypes of CVD and to estimate years lived with and without CVD by weight status. DESIGN, SETTING, AND PARTICIPANTS In this population-based study, we used pooled individual-level data from adults (baseline age, 20-39, 40-59, and 60-79 years) across 10 large US prospective cohorts, with 3.2 million person-years of follow-up from 1964 to 2015. All participants were free of clinical CVD at baseline with available BMI index and CVD outcomes data. Data were analyzed from October 2016 to July 2017. EXPOSURES World Health Organization-standardized BMI categories. MAIN OUTCOMES AND MEASURES Total CVD and CVD subtype, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. Heights and weights were measured directly by investigators in each study, and BMI was calculated as weight in kilograms divided by height in meters squared. We performed (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) the Irwin restricted mean to estimate years lived free of and with CVD. RESULTS Of the 190 672 in-person examinations included in this study, the mean (SD) age was 46.0 (15.0) years for men and 58.7 (12.9) years for women, and 140 835 patients (73.9%) were female. Compared with individuals with a normal BMI (defined as a BMI of 18.5 to 24.9), lifetime risks for incident CVD were higher in middle-aged adults in the overweight and obese groups. Compared with normal weight, among middle-aged men and women, competing hazard ratios for incident CVD were 1.21 (95% CI, 1.14-1.28) and 1.32 (95% CI, 1.24-1.40), respectively, for overweight (BMI, 25.0-29.9), 1.67 (95% CI, 1.55-1.79) and 1.85 (95% CI, 1.72-1.99) for obesity (BMI, 30.0-39.9), and 3.14 (95% CI, 2.48-3.97) and 2.53 (95% CI, 2.20-2.91) for morbid obesity (BMI, 40.0). Higher BMI had the strongest association with incident heart failure among CVD subtypes. Average years lived with CVD were longer for middle-aged adults in the overweight and obese groups compared with adults in the normal BMI group. Similar patterns were observed in younger and older adults. CONCLUSIONS AND RELEVANCE In this study, obesity was associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI. Despite similar longevity compared with normal BMI, overweight was associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity.

Original languageEnglish (US)
Pages (from-to)280-287
Number of pages8
JournalJAMA cardiology
Volume3
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Body Mass Index
Cardiovascular Diseases
Morbidity
Weights and Measures
Heart Failure
Obesity
Morbid Obesity
Mortality
Kaplan-Meier Estimate
Proportional Hazards Models
Coronary Disease
Young Adult
Stroke
Research Personnel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a08c39ce4c494316a607888701ee304e,
title = "Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity",
abstract = "IMPORTANCE Prior studies have demonstrated lower all-cause mortality in individuals who are overweight compared with those with normal body mass index (BMI), but whether this may come at the cost of greater burden of cardiovascular disease (CVD) is unknown. OBJECTIVE To calculate lifetime risk estimates of incident CVD and subtypes of CVD and to estimate years lived with and without CVD by weight status. DESIGN, SETTING, AND PARTICIPANTS In this population-based study, we used pooled individual-level data from adults (baseline age, 20-39, 40-59, and 60-79 years) across 10 large US prospective cohorts, with 3.2 million person-years of follow-up from 1964 to 2015. All participants were free of clinical CVD at baseline with available BMI index and CVD outcomes data. Data were analyzed from October 2016 to July 2017. EXPOSURES World Health Organization-standardized BMI categories. MAIN OUTCOMES AND MEASURES Total CVD and CVD subtype, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. Heights and weights were measured directly by investigators in each study, and BMI was calculated as weight in kilograms divided by height in meters squared. We performed (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) the Irwin restricted mean to estimate years lived free of and with CVD. RESULTS Of the 190 672 in-person examinations included in this study, the mean (SD) age was 46.0 (15.0) years for men and 58.7 (12.9) years for women, and 140 835 patients (73.9{\%}) were female. Compared with individuals with a normal BMI (defined as a BMI of 18.5 to 24.9), lifetime risks for incident CVD were higher in middle-aged adults in the overweight and obese groups. Compared with normal weight, among middle-aged men and women, competing hazard ratios for incident CVD were 1.21 (95{\%} CI, 1.14-1.28) and 1.32 (95{\%} CI, 1.24-1.40), respectively, for overweight (BMI, 25.0-29.9), 1.67 (95{\%} CI, 1.55-1.79) and 1.85 (95{\%} CI, 1.72-1.99) for obesity (BMI, 30.0-39.9), and 3.14 (95{\%} CI, 2.48-3.97) and 2.53 (95{\%} CI, 2.20-2.91) for morbid obesity (BMI, 40.0). Higher BMI had the strongest association with incident heart failure among CVD subtypes. Average years lived with CVD were longer for middle-aged adults in the overweight and obese groups compared with adults in the normal BMI group. Similar patterns were observed in younger and older adults. CONCLUSIONS AND RELEVANCE In this study, obesity was associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI. Despite similar longevity compared with normal BMI, overweight was associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity.",
author = "Khan, {Sadiya Sana} and Hongyan Ning and Wilkins, {John T} and Allen, {Norrina Bai} and Carnethon, {Mercedes R} and Berry, {Jarett D.} and Sweis, {Ranya Nabil} and Lloyd-Jones, {Donald M}",
year = "2018",
month = "4",
day = "1",
doi = "10.1001/jamacardio.2018.0022",
language = "English (US)",
volume = "3",
pages = "280--287",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
number = "4",

}

TY - JOUR

T1 - Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity

AU - Khan, Sadiya Sana

AU - Ning, Hongyan

AU - Wilkins, John T

AU - Allen, Norrina Bai

AU - Carnethon, Mercedes R

AU - Berry, Jarett D.

AU - Sweis, Ranya Nabil

AU - Lloyd-Jones, Donald M

PY - 2018/4/1

Y1 - 2018/4/1

N2 - IMPORTANCE Prior studies have demonstrated lower all-cause mortality in individuals who are overweight compared with those with normal body mass index (BMI), but whether this may come at the cost of greater burden of cardiovascular disease (CVD) is unknown. OBJECTIVE To calculate lifetime risk estimates of incident CVD and subtypes of CVD and to estimate years lived with and without CVD by weight status. DESIGN, SETTING, AND PARTICIPANTS In this population-based study, we used pooled individual-level data from adults (baseline age, 20-39, 40-59, and 60-79 years) across 10 large US prospective cohorts, with 3.2 million person-years of follow-up from 1964 to 2015. All participants were free of clinical CVD at baseline with available BMI index and CVD outcomes data. Data were analyzed from October 2016 to July 2017. EXPOSURES World Health Organization-standardized BMI categories. MAIN OUTCOMES AND MEASURES Total CVD and CVD subtype, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. Heights and weights were measured directly by investigators in each study, and BMI was calculated as weight in kilograms divided by height in meters squared. We performed (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) the Irwin restricted mean to estimate years lived free of and with CVD. RESULTS Of the 190 672 in-person examinations included in this study, the mean (SD) age was 46.0 (15.0) years for men and 58.7 (12.9) years for women, and 140 835 patients (73.9%) were female. Compared with individuals with a normal BMI (defined as a BMI of 18.5 to 24.9), lifetime risks for incident CVD were higher in middle-aged adults in the overweight and obese groups. Compared with normal weight, among middle-aged men and women, competing hazard ratios for incident CVD were 1.21 (95% CI, 1.14-1.28) and 1.32 (95% CI, 1.24-1.40), respectively, for overweight (BMI, 25.0-29.9), 1.67 (95% CI, 1.55-1.79) and 1.85 (95% CI, 1.72-1.99) for obesity (BMI, 30.0-39.9), and 3.14 (95% CI, 2.48-3.97) and 2.53 (95% CI, 2.20-2.91) for morbid obesity (BMI, 40.0). Higher BMI had the strongest association with incident heart failure among CVD subtypes. Average years lived with CVD were longer for middle-aged adults in the overweight and obese groups compared with adults in the normal BMI group. Similar patterns were observed in younger and older adults. CONCLUSIONS AND RELEVANCE In this study, obesity was associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI. Despite similar longevity compared with normal BMI, overweight was associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity.

AB - IMPORTANCE Prior studies have demonstrated lower all-cause mortality in individuals who are overweight compared with those with normal body mass index (BMI), but whether this may come at the cost of greater burden of cardiovascular disease (CVD) is unknown. OBJECTIVE To calculate lifetime risk estimates of incident CVD and subtypes of CVD and to estimate years lived with and without CVD by weight status. DESIGN, SETTING, AND PARTICIPANTS In this population-based study, we used pooled individual-level data from adults (baseline age, 20-39, 40-59, and 60-79 years) across 10 large US prospective cohorts, with 3.2 million person-years of follow-up from 1964 to 2015. All participants were free of clinical CVD at baseline with available BMI index and CVD outcomes data. Data were analyzed from October 2016 to July 2017. EXPOSURES World Health Organization-standardized BMI categories. MAIN OUTCOMES AND MEASURES Total CVD and CVD subtype, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. Heights and weights were measured directly by investigators in each study, and BMI was calculated as weight in kilograms divided by height in meters squared. We performed (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) the Irwin restricted mean to estimate years lived free of and with CVD. RESULTS Of the 190 672 in-person examinations included in this study, the mean (SD) age was 46.0 (15.0) years for men and 58.7 (12.9) years for women, and 140 835 patients (73.9%) were female. Compared with individuals with a normal BMI (defined as a BMI of 18.5 to 24.9), lifetime risks for incident CVD were higher in middle-aged adults in the overweight and obese groups. Compared with normal weight, among middle-aged men and women, competing hazard ratios for incident CVD were 1.21 (95% CI, 1.14-1.28) and 1.32 (95% CI, 1.24-1.40), respectively, for overweight (BMI, 25.0-29.9), 1.67 (95% CI, 1.55-1.79) and 1.85 (95% CI, 1.72-1.99) for obesity (BMI, 30.0-39.9), and 3.14 (95% CI, 2.48-3.97) and 2.53 (95% CI, 2.20-2.91) for morbid obesity (BMI, 40.0). Higher BMI had the strongest association with incident heart failure among CVD subtypes. Average years lived with CVD were longer for middle-aged adults in the overweight and obese groups compared with adults in the normal BMI group. Similar patterns were observed in younger and older adults. CONCLUSIONS AND RELEVANCE In this study, obesity was associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI. Despite similar longevity compared with normal BMI, overweight was associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity.

UR - http://www.scopus.com/inward/record.url?scp=85046029698&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046029698&partnerID=8YFLogxK

U2 - 10.1001/jamacardio.2018.0022

DO - 10.1001/jamacardio.2018.0022

M3 - Article

VL - 3

SP - 280

EP - 287

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 4

ER -