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Published on: September 29, 2017
Relation between adiposity and vascular events, malignancy and mortality in patients with stable cerebrovascular
N E M Jaspers1, J A N Dorresteijn1, Y van der Graaf2
1Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
For patients with stable cerebrovascular disease (CeVD), a body mass index (BMI) of 27-28 kg/m² is linked to the lowest mortality risk. However, increased abdominal obesity independently raises the risk of all-cause mortality.
Area of Science:
- Cardiology
- Neurology
- Obesity Research
Background:
- Abdominal adiposity is a known risk factor for hypertension and cardiovascular events.
- The relationship between body mass index (BMI) and cardiovascular events often follows a U-shaped curve.
- The specific impact of abdominal adiposity on mortality and morbidity in patients with stable cerebrovascular disease (CeVD) requires further clarification.
Purpose of the Study:
- To investigate the association between various adiposity measurements and the risk of vascular events, vascular mortality, malignancy, and all-cause mortality in patients with stable CeVD.
- To determine optimal reference values for adiposity measurements in this patient population.
Main Methods:
- Prospective follow-up of 1767 patients with stable CeVD for a median of 6.8 years.
- Assessment of adiposity using BMI, waist circumference (stratified by gender), and visceral adipose tissue percentage (VAT%) via ultrasound.
- Analysis of relationships using multivariable adjusted Cox proportional hazards models, assessing nonlinearity with a chi-squared test.
Main Results:
- Nonlinear relationships were observed between BMI and outcomes, with nadirs for vascular mortality and malignancy around 27.1-28.1 kg/m².
- A nonlinear relationship between waist circumference and all-cause mortality was found, with nadirs of 84.0 cm for females and 94.8 cm for males.
- A 1-SD (9.8%) increase in VAT% was associated with increased vascular (HR 1.23) and all-cause mortality (HR 1.22), with no nonlinearity detected for VAT%.
Conclusions:
- In patients with CeVD, a BMI of approximately 27-28 kg/m² is associated with the lowest risk of vascular events, vascular mortality, malignancy, and all-cause mortality.
- Increasing abdominal adiposity, as measured by waist circumference and VAT%, is independently linked to a higher risk of all-cause mortality.
- While traditional BMI cutoffs may need re-evaluation in CeVD patients, maintaining low abdominal obesity remains a crucial clinical goal.
Background:
Abdominal adiposity is associated with various risk factors including hypertension, and is therefore particularly relevant in patients with stable cerebrovascular disease (CeVD). A U-shaped relation between body mass index (BMI, kg m-2) and cardiovascular events is often described. Whether this U-shape persists for abdominal adiposity, and consequently which reference values should guide clinical practice, is unclear. We described the relation between multiple adiposity measurements and risk of vascular events, vascular mortality, malignancy and all-cause mortality in patients with clinically stable CeVD.
Methods:
During a median follow-up time of 6.8 years, 1767 patients were prospectively followed. Relations were assessed using multivariable adjusted Cox proportional hazards models. Adiposity was assessed with BMI, waist circumference (stratified by gender) and the contribution of visceral fat to total abdominal fat (VAT%) measured using ultrasound. Relations were nonlinear if the χ2-statistic of the nonlinear term was significant (P-value<0.05). Nadirs were reported for nonlinear and hazard ratios (HRs) for linear relations.
Results:
The relations between BMI and outcomes were nonlinear with nadirs ranging between 27.1 (95% confidence interval (CI) 21.9-29.3) kg m2 for vascular mortality and 28.1 (95% CI, 19.0-38.2)) kg m-2 for malignancy. The relation between waist circumference and all-cause mortality was nonlinear with a nadir of 84.0 (95% CI, 18.7-134.8) cm for females and 94.8 (95% CI, 80.3-100.1) cm for males. No nonlinearity was detected for VAT%. A 1-s.d. (9.8%) increase in VAT% was related to both vascular (HR, 1.23, 95% CI 1.00-1.51) and all-cause mortality (HR, 1.22, 95% CI 1.05-1.42).
Conclusions:
In patients with CeVD, a BMI around 27-28 kg m-2 relates to the lowest risk of vascular events, vascular mortality, malignancy and all-cause mortality. However, increasing abdominal adiposity confers a higher risk of all-cause mortality. Thus, whereas traditional BMI cutoffs may be re-evaluated in this population, striving for low abdominal obesity should remain a goal.
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