The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent

Iliodromiti, S. et al. (2018) The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent. European Heart Journal, 39(17), pp. 1514-1520. (doi:10.1093/eurheartj/ehy057) (PMID:29718151) (PMCID:PMC5930252)

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Abstract

Aims: The data regarding the associations of body mass index (BMI) with cardiovascular (CVD) risk, especially for those at the low categories of BMI, are conflicting. The aim of our study was to examine the associations of body composition (assessed by five different measures) with incident CVD outcomes in healthy individuals. Methods and results: A total of 296 535 participants (57.8% women) of white European descent without CVD at baseline from the UK biobank were included. Exposures were five different measures of adiposity. Fatal and non-fatal CVD events were the primary outcome. Low BMI (≤18.5 kg m−2) was associated with higher incidence of CVD and the lowest CVD risk was exhibited at BMI of 22–23 kg m−2 beyond, which the risk of CVD increased. This J-shaped association attenuated substantially in subgroup analyses, when we excluded participants with comorbidities. In contrast, the associations for the remaining adiposity measures were more linear; 1 SD increase in waist circumference was associated with a hazard ratio of 1.16 [95% confidence interval (CI) 1.13–1.19] for women and 1.10 (95% CI 1.08–1.13) for men with similar magnitude of associations for 1 SD increase in waist-to-hip ratio, waist-to-height ratio, and percentage body fat mass. Conclusion: Increasing adiposity has a detrimental association with CVD health in middle-aged men and women. The association of BMI with CVD appears more susceptible to confounding due to pre-existing comorbidities when compared with other adiposity measures. Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Celis, Dr Carlos and Gray, Dr Stuart and Gill, Professor Jason and Welsh, Dr Paul and Anderson, Dr Jana and Iliodromiti, Dr Stamatina and Pell, Professor Jill and Nelson, Professor Scott and Mackay, Dr Daniel and Sattar, Professor Naveed and Lyall, Dr Donald
Authors: Iliodromiti, S., Celis-Morales, C. A., Lyall, D. M., Anderson, J., Gray, S. R., Mackay, D. F., Nelson, S. M., Welsh, P., Pell, J. P., Gill, J. M.R., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
Published Online:16 March 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Heart Journal 39(17):1514-1520
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES
603151EMIFNaveed SattarEuropean Commission (EC)115372RI CARDIOVASCULAR & MEDICAL SCIENCES
695091Women's reproductive health and its relation to diabetes and cardiovascular healthStamatina IliodromitiMedical Research Council (MRC)MR/N015177/1MVLS MED - REPRODUCTIVE & MATERNAL MED