Abstract 09: Excess Weight, Cardiovascular Events, and Healthy Longevity: The Lifetime Risk Pooling Project
Background: Compared with normal BMI, overweight status (body-mass index [BMI] 25.0-29.9 kg/m2) appears to be associated with greater longevity, but it is unclear to what extent this comes at the expense of greater burden of cardiovascular disease (CVD) and years lived with CVD.
Methods: We pooled individual-level data from 10 prospective cohorts and included adults free from CVD, stratified by index age (20-39, 40-59, and 60-79 years). We used: (1) modified Kaplan-Meier analysis to estimate lifetime risks for CVD events and non-cardiovascular death; (2) Irwin’s restricted mean to estimate years lived free from and with CVD; and (3) adjusted competing Cox models to estimate joint cumulative risks for CVD or non-cardiovascular death.
Results: The mean (SD) baseline BMI in middle-age (ages 40-59 years) was 27.4 (4.1) kg/m2 for men and 27.1 (6.0) kg/m2 for women. Through 72,490 person-years of follow-up, 13,457 CVD events (coronary heart disease, stroke, and heart failure; including 6,309 CVD deaths) and 11,782 non-CVD deaths occurred in middle-aged participants. Compared with normal BMI, lifetime risks for CVD were higher in overweight and obese adults. Average years lived free from CVD were longest for normal BMI individuals, whereas years lived with CVD were longer for overweight and obese (FIGURE). Compared with middle-aged men and women, respectively, with normal BMI, competing hazards ratios (95% CI) for incident CVD were 1.21 (1.14-1.28) and 1.32 (1.24-1.40) for BMI 25.0-29.9; 1.67 (1.55-1.79) and 1.85 (1.72-1.99) for BMI 30-39.9; and 3.14 (2.48-3.97) and 2.53 (2.20-2.91) for BMI 40.0 and greater. Similar patterns were observed in younger and older adults.
Conclusions: Compared with normal BMI, both overweight and obesity are associated with similar or shorter total longevity and more years of life lived with CVD. These data suggest that the “obesity/overweight paradox” present after the diagnosis of CVD occurs because of earlier onset of CVD.
Author Disclosures: S.S. Khan: None. H. Ning: None. J.T. Wilkins: None. N.B. Allen: None. M. Carnethon: None. J.D. Berry: None. R.N. Sweis: None. D.M. Lloyd-Jones: None.
- © 2017 by American Heart Association, Inc.