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Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records
Michail Katsoulis1,2, Bianca D Stavola3, Karla Diaz-Ordaz4
1From the Institute of Health Informatics, University College London (UCL), London, United Kingdom.
Epidemiology (Cambridge, Mass.)
|August 4, 2021
Summary
Weight change impacts cardiovascular disease (CVD) risk. Both weight loss and gain increased CVD risk in normal-weight and overweight individuals. Obese individuals who lost weight had lower coronary heart disease risk.
Area of Science:
- Cardiovascular disease research
- Obesity and weight management
- Public health and epidemiology
Background:
- Cross-sectional body mass index (BMI) measures link to cardiovascular disease (CVD) incidence.
- The impact of weight change on CVD risk remains less understood.
- This study investigates weight change effects on long-term CVD risk.
Purpose of the Study:
- To estimate the effect of 2-year weight change interventions on 7-year CVD risk.
- To emulate hypothetical interventions using electronic health records.
- To analyze CVD risk across different weight change categories (loss, maintenance, gain).
Main Methods:
- Utilized electronic health records of 138,567 individuals (aged 45-69) in England (1998-2016).
- Emulated hypothetical 2-year weight change interventions to predict 7-year CVD risk.
- Employed pooled logistic regression with inverse-probability weighting for confounder adjustment.
Main Results:
- Normal-weight individuals: weight loss (RD 1.5%) and gain (RD 1.3%) increased CVD risk versus maintenance.
- Overweight individuals: weight loss (RD 0.7%) and gain (RD 0.7%) showed moderately higher CVD risk versus maintenance.
- Obese individuals: weight loss reduced coronary heart disease risk (RD -1.4%) but not stroke risk.
Conclusions:
- Weight gain increases CVD risk across all body mass index (BMI) groups.
- Weight loss in obese individuals is associated with lower coronary heart disease risk.
- Weight change effects on CVD risk vary depending on baseline BMI and direction of weight change.
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