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Risk stratification of obesity as a coronary risk factor
William B Kannel1, Peter W F Wilson, Byung-Ho Nam
1Framingham Study, Boston University School of Medicine, Framingham, Massachusetts, USA. billkannel@yahoo.com
Insights
Obesity significantly increases coronary heart disease (CHD) risk due to clustered risk factors. Identifying and managing these factors in overweight and obese individuals is crucial for preventing heart attacks and improving cardiovascular health.
Area of Science:
- Cardiovascular Epidemiology
- Obesity Research
- Preventive Cardiology
Background:
- Overweight and obesity are prevalent conditions linked to increased cardiovascular disease risk.
- Understanding the interplay between weight status and coronary heart disease (CHD) risk factors is essential for targeted interventions.
Purpose of the Study:
- To investigate the prevalence of CHD risk factor clustering in overweight and obese individuals.
- To determine the impact of these risk factor clusters on myocardial infarction and coronary mortality.
Main Methods:
- Analysis of data from the Framingham Study cohort, including overweight (BMI 25-29) and obese (BMI ≥30) participants.
- Follow-up for 16 years to assess CHD events (myocardial infarction, coronary mortality).
- Categorization of risk factors including hypertension, dyslipidemia, smoking, diabetes, and left ventricular hypertrophy.
Main Results:
- Obese individuals exhibited significantly higher age-adjusted risk ratios for CHD compared to lean individuals (1.48 for men, 2.09 for women).
- Risk factor clustering was substantially more frequent in obese individuals (56% of men, 62.4% of women) than in lean subjects.
- Obese individuals with three or more risk factors had a markedly elevated risk of developing CHD (2.07 for men, 10.9 for women).
Conclusions:
- Overweight and obesity promote clustering of CHD risk factors, amplifying their impact on cardiovascular hazard.
- Global risk assessment is vital for identifying high-risk overweight and obese individuals needing urgent risk factor modification and weight management.
Abstract:
We examined the extent of coronary heart disease (CHD) risk factor clustering in overweight persons with a body mass index (BMI) of 25 to 29 and an obesity BMI of >/=30 and the influence of this on the hazard of myocardial infarction and coronary mortality. A total of 1,309 men and 739 women aged 30 to 74 years, initially free of cardiovascular disease, comprised the overweight subject group, and 375 men and 356 women comprised the obese subject group at risk. The sample was derived from the original Framingham Study cohort at the 11th biennial examination, and their offspring at initial examination. During 16 years of follow-up of overweight subjects, 188 men and 44 women had CHD events, indicating an age-adjusted rate that was not much different from the slim subjects. In the obese subject group, 72 men and 37 women developed CHD, corresponding to age-adjusted risk ratios 1.48 times that of lean men, and 2.09 times that of lean women. Risk factors were categorized as systolic blood pressure >/=140 mm Hg, total cholesterol >/=240 mg/dl, high-density lipoprotein (HDL) cholesterol <35 mg/dl for men and <40 mg/dl for women, heart rate >80 beats/min, history of smoking, history of type 2 diabetes, and electrocardiographic left ventricular hypertrophy. Being overweight occurred in isolation of CHD risk factors in 22% of men and in 16.4% of women. Being obese occurred in isolation in only 12.8% of men and 9% of women. Clusters of >/=2 risk factors occurred in 56% of obese men and in 62.4% of obese women, a frequency substantially exceeding that in slim subjects. Compared with obese men without risk factors, those with >/=3 factors had a 2.07 age-adjusted relative risk of developing CHD, and obese women had a 10.9 relative risk (p <0.05). Being overweight and obese promotes clusters of CHD risk factors that greatly influence their impact. Global risk assessment can identify high-risk overweight candidates for CHD who most urgently need correction of associated risk factors, as well as sustained weight reduction.