Abstract 4103: Projected Increase in Rates of Future Adult Coronary Heart Disease Associated with Current Adolescent Obesity
BACKGROUND: Overweight adolescents often become obese adults, resulting in adverse health effects. The impact of the current overweight epidemic among adolescents on future adult coronary heart disease (CHD) is not known.
METHODS: The CHD Policy Model is a state-transition, computer simulation of the US population, age 35 and over. Inputs include national data on the joint distribution of risk factors, rates of CHD events, and case fatality rates; and β coefficients for risk factors based on Framingham and other studies. The Model is calibrated to reproduce, in its baseline year of 2000, all key outcomes in the US to within <1% and the results of relevant clinical trials. Using data from the National Health and Nutrition Examination Survey (NHANES) I (71–74), II (76– 80), III (88–94), and 99– 00, we determined the prevalence of overweight adolescents (age 12–19) and obese young adults (age 25–35) and estimated trends as overweight adolescents become obese adults. We then estimated the prevalence of future obese 35 year-olds based on the prevalence of overweight adolescents in 1999–2000. We determined the rates of new CHD, myocardial infarction (MI), and CHD deaths over 30 years, and calculated the excess events attributable to the higher prevalence of obesity. We assumed no additional BMI increase among adults. Based on the latest epidemiologic data, we assumed that higher BMI was not independently associated with CHD, but increased CHD rates through higher diastolic blood pressure, dyslipidemia, and higher rates of diabetes.
RESULTS: Adolescent overweight was projected to increase the prevalence of obesity among 35 year-olds from 32.6 to 41.6% of men and 36.7 to 42.7% of women. From age 35– 65, this increased obesity attributed to adolescent overweight would result in a 6% increase in overall CHD events, leading to 547,000 excess new CHD cases, 167,000 excess MIs, and 64,000 excess CHD deaths. The incremental effect of adolescent obesity on adult CHD events is highest among 35– 45 year-olds, whose rate of new CHD events increases by 9%.
CONCLUSIONS: Current overweight among adolescents will substantially increase the rate of CHD among future young and middle-aged adults. Reducing overweight among adolescents may yield considerable health benefits in adulthood.