Abstract 13698: Combining Smoking Habits and Obesity Status for Prediction of Cardiovascular Disease in Hypertensive Patients: A 4-Year Follow-Up Study
Introduction: Smoking and obesity are established contributors of cardiovascular disease, yet the prognosis of possible combinations of these risk factors is unclear.
Hypothesis: We investigated the cardiovascular morbidity risks of hypertensive patients based on their smoking habits and adiposity levels.
Methods: We followed 1630 normal weight-to-mildly obese, hypertensive patients for a mean period of 3.9±1.7 years. At the initial examination, current smoking was recorded as smoking at least one cigarette daily. Body mass index (BMI) served as the adiposity measure and excess weight was defined as a BMI≥25kg/m2. Based on the smoking habits and BMI, four groups were identified: normal weight/non-smokers (n=246, 15% of the total population), excess weight/non-smokers (n=947, 58%), normal weight/smokers (n=127, 8%) and excess weight/smokers (n=310, 19%). Patients underwent regular visits for blood pressure and risk factor management. Endpoint of interest was cardiovascular morbidity set as the composite of coronary heart disease and stroke and normal weight/non-smokers served as the reference group.
Results: Incidence of cardiovascular events was increasingly higher among groups with 5.3 cardiovascular events per 1,000 patient-years in normal weight/non-smokers, 6.9 events per 1,000 patient-years in excess weight/non-smokers, 10.7 events per 1,000 patient-years in normal weight/smokers and 14.7 events per 1,000 patient-years in excess weight/smokers. Multivariate cox regression revealed that after introducing both smoking and excess weight into a model controlling for traditional risk factors, only smoking was associated with a significantly higher risk of 2.52 (CI: 1.43-4.45, p=0.002) for cardiovascular events. Unadjusted analysis also revealed a trend for an increasing risk among groups that was significant for excess weight/smokers (HR:2.92, CI:1.08-7.89, p=0.034). This pattern was sustained but overall attenuated after controlling for risk factors.
Conclusions: In normal to mildly obese hypertensive patients, smoking is a stronger predictor of cardiovascular disease compared to excess weight. Combination of smoking with the at least overweight phenotype has the most adverse prognosis.
- © 2013 by American Heart Association, Inc.