Abstract 17400: Adiposity Over the Life-course and Risk of Sudden Cardiac Death in Women
Background: Sudden cardiac death (SCD) is often the first manifestation of CHD among women, necessitating prevention strategies in this apparently healthy subset of the population. Elevated BMI has been associated with greater short-term risk of SCD among women, thus prevention of obesity may be an effective means to lower the population-wide burden of SCD. The relation of obesity and weight gain in early adulthood on SCD risk is unknown.
Methods: We examined the associations between BMI (kg/m2) in early adulthood (age 18), during midlife (at baseline, mean age 46) and throughout adulthood with risk of SCD among 84,117 women enrolled in the Nurses’ Health Study who were free from CVD, cancer and other chronic diseases in 1980. Data on attained height, weight at age 18, current weight and other factors were obtained via a questionnaire at baseline; current weight was updated biannually. SCD was defined as death occurring within 1 hour of symptom onset without circulatory collapse. We estimated relative risks (RR) in time-varying Cox proportional hazard models adjusting for age, CVD risk factors and diagnosed CVD.
Results: Over 32 years, 331 SCDs occurred in this healthy population. Higher BMI in early and midlife was associated with greater risk of SCD (Figure). Women with a BMI ≥35.0 at these points had 3-4 fold greater risk of SCD, which persisted when women who developed incident CHD were excluded. Women who gained ≥20 kg from age 18 until midlife had a RR of 1.74 (95%CI 1.22, 2.46), controlling for BMI at age 18, compared to women who maintained a stable weight. In contrast, the relation of BMI updated every 2 years with SCD risk was U-shaped, and risk at BMI ≥35.0 was 2-fold higher (Figure).
Conclusion: Elevated BMI earlier in the life course (early and midlife), and weight gain in early adulthood, was associated with greater SCD risk among women. Strategies for the prevention of weight gain and obesity initiated earlier in life may provide substantial benefit for disease prevention.
- © 2013 by American Heart Association, Inc.