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Higher BMI (Obesity Marker): Earlier onset of incident CVD followed by Shorter overall Survival – Men and women of all ages

Reporter: Aviva Lev-Ari, PhD, RN

Men and women of all ages with a higher BMI were found to have both an earlier onset of incident CVD followed by shorter overall survival, Sadiya Khan, MD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues wrote in JAMA Cardiology.

Among middle-aged men, there were 13,457 incident CVD events total, with the highest percentage attributed to fatal or nonfatal myocardial infarctions. This incidence rate of CVD events increased accordingly with BMI range, with the highest seen in those who were morbidly obese. Compared with men who died due to non-CVD related causes — the most common of which was cancer — men who weighed more had a significantly higher rate of experiencing their first CVD event.

When compared to middle-aged men of normal weight, those in higher BMI categories had an increased incidence of CVD:

• Overweight: adjusted competing HR 1.21 (95% CI 1.14-1.28)
• Obese: 1.67 (95% CI 1.55-1.79)
• Morbidly obese: 3.14 (95% CI 2.48-3.97)

Similar event rates were seen among middle-aged women of a higher BMI, as well:

• Overweight: HR 1.32 (95% CI 1.24-1.40)
• Obese 1.85 (95% CI 1.72-1.99)
• Morbidly obese: 2.53 (95% CI 2.20-2.91)

Both men and women had a longer time to first CVD event if they were of normal weight by around 7.5 year and 7.1 years, respectively, when compared with people with morbid obesity.

The researchers noted that the morbidly obese category likely saw the highest rate of CVD events mainly due to a five-fold increase in the incidence of congestive heart failure events. These patterns were also seen in the younger and older age groups.

Although the notion of the “obesity paradox” — when people with a higher BMI might actually live longer after CVD onset compared to those of normal weight — has been described in some prior studies, the researchers noted that their findings suggest that “this occurs because of a trend toward earlier onset of disease in individuals who are overweight and obese.”

 

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