Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE
Alexandra Dudina1, Marie Therese Cooney, Dirk De Bacquer
1Department of Cardiology Adelaide Meath Hospital, Tallaght, Dublin, Ireland.
Insights
Obesity significantly increases cardiovascular disease (CVD) mortality, especially in younger individuals and women. While overweight and obesity are linked to higher CVD death rates, this risk is partly mediated by other factors like blood pressure and cholesterol.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) remains a leading global cause of death.
- Despite falling CVD mortality rates in developed nations, rising obesity levels pose a significant public health concern.
- Obesity may offset positive trends in cardiovascular health.
Purpose of the Study:
- To investigate the relationship between body mass index (BMI) and CVD mortality using the Systematic Coronary Risk Evaluation (SCORE) data.
- To analyze how BMI interacts with conventional CVD risk factors in relation to mortality.
- To stratify findings by age and gender.
Main Methods:
- Utilized the SCORE dataset, comprising data from 12 European cohort studies.
- Employed univariable and multivariable (Cox) analyses to examine BMI and CVD mortality.
- Stratified the population by gender and age groups (under 40, 40-49, 50-59, over 60) to assess CVD mortality rates within BMI categories.
Main Results:
- A strong, J-shaped relationship was observed between BMI and CVD mortality in both genders.
- Each 5-unit increase in BMI correlated with a 34% increase in CVD mortality for men and 29% for women.
- The association between BMI and CVD mortality persisted after adjusting for age, smoking, total cholesterol, and systolic blood pressure, but diminished upon further adjustment for diabetes and HDL cholesterol.
Conclusions:
- Overweight and obesity are strongly and progressively linked to CVD mortality, with greater effects observed in women and younger individuals.
- A significant portion of BMI-associated CVD mortality risk appears to be mediated by other established CVD risk factors.
- Body mass index (BMI) is a crucial indicator and mediator of cardiovascular risk, underscoring its public health importance.
Background:
Although cardiovascular disease (CVD) is the biggest global cause of death, CVD mortality is falling in developed countries. There is concern that this trend may be offset by increasing levels of obesity.
Design:
We used the Systematic Coronary Risk Evaluation (SCORE) data set to examine relationships between body mass index (BMI), conventional risk factors and CVD mortality.
Methods:
The SCORE data set comprises data from 12 European cohort studies. The relationship between BMI and CVD mortality was examined in each BMI category using univariable and multivariable (Cox) analyses. The SCORE population was also divided into gender and age strata: under 40, 40-49, 50-59, and over 60. The rate of CVD mortality in each BMI category was calculated within each gender and age stratum. Relationships between BMI and other CVD risk factors were also examined.
Results:
There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders. Each 5-unit increase in BMI was associated with an increase in CVD mortality of 34% in men and 29% in women. The hazard ratios remained significant when adjusted for age, self-reported smoking status, total cholesterol, and systolic blood pressure (SBP). On additional adjustment for diabetes and high-density lipoprotein cholesterol (HDL), the association between BMI and CVD mortality did not persist. In all age groups except those over 60 there were significant relationships between increased BMI and CVD mortality. In the over-60 age group the only significant relationships with mortality were in underweight and severely overweight women and mildly obese men. After adjustment for age, each 1-unit increase in BMI was associated with a 1.14 mmHg increase in SBP, 0.055 mmol/l increase in total cholesterol, and a 0.024 mmol/l decrease in HDL in men. Figures were slightly lower in women.
Conclusions:
Overall, overweight and obesity relate to CVD mortality in a strong and graded manner. The effects are greater in women and markedly so in younger persons. It is likely that a substantial part of the BMI-associated risk of CVD mortality is mediated through other known CVD risk factors. This increases the public health importance of BMI as both a simple indicator and mediator of CVD risk.
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