Prevalence and Association of Myocardial Infarction among Overweight Adults in the United States

Excess body weight is widely recognized as a contributor to cardiovascular disease; however, its relationship with myocardial infarction (MI) is not uniform across population subgroups. Demographic characteristics and socioeconomic conditions may substantially modify this association. Large, nationally representative studies are therefore needed to better delineate these differences and guide more equitable prevention strategies.

To examine the association between overweight status (body mass index [BMI] >25 kg/m²) and self-reported MI among U.S. adults, with particular attention to variation across demographic and socioeconomic groups.

We conducted a cross-sectional analytical study using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS). Overweight status was defined using the BRFSS calculated variable _RFBMI5 (BMI >25 kg/m²). MI was identified using the self-reported variable CVDINFR4. Crude associations between overweight and MI were evaluated using univariate logistic regression, both overall and stratified by age, sex, race/ethnicity, educational attainment, and household income. Multivariable logistic regression models were then used to estimate adjusted odds ratios (aORs) after controlling for relevant demographic and socioeconomic factors. All analyses incorporated BRFSS survey weights to generate nationally representative estimates.

The study included 390,751 adults. Individuals classified as overweight had significantly higher odds of reporting a prior MI compared with those with BMI ≤25 kg/m² (odds ratio 1.35, 95% confidence interval [CI] 1.31-1.39). This association was most pronounced among middle-aged adults and was not observed in participants aged 18-24 years. In adjusted analyses, overweight remained independently associated with MI (aOR 1.18, 95% CI: 1.08-1.29). Increasing age and male sex emerged as the strongest predictors of MI. In addition, lower levels of education and household income showed robust independent associations with MI, exceeding the magnitude of risk attributable to overweight alone.

Overweight is independently associated with MI in U.S. adults; however, demographic and socioeconomic factors - particularly age, sex, and socioeconomic disadvantage - play a more dominant role in shaping MI prevalence. Cardiovascular prevention efforts should therefore combine weight-focused interventions with broader strategies addressing social determinants of health.