Higher body mass index in adolescence predicts cardiomyopathy risk in midlife: long-term follow-up among Swedish men

Robertson, J., Schaufelberger, M., Lindgren, M., Adiels, M., Schiöler, L., Torén, K., McMurray, J. , Sattar, N. , Åberg, M. and Rosengren, A. (2019) Higher body mass index in adolescence predicts cardiomyopathy risk in midlife: long-term follow-up among Swedish men. Circulation, 140, pp. 117-125. (doi: 10.1161/circulationaha.118.039132) (PMID:31132859) (PMCID:PMC6635044)

Abstract

Background: Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. Methods: This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. Results: During follow-up (median, 27 years; Q1-Q3, 19-35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/ drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5-<25 kg/m2; hazard ratio, 1.38 [95% CI, 1.22-1.57]), adjusted for age, year, center, and baseline comorbidities, and with a >8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14-1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06-1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06-1.13) for alcohol/drug-induced cardiomyopathy. Conclusions: Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease.

• Item Type: Articles
• Additional Information: This study was supported by grants from the Swedish state under an agree-ment concerning economic support of research and education of doctors (ALF-GBG-427301, 433511), the Swedish Research Council (2013-5187 [SIMSAM] and 2013-4236), the Swedish Heart and Lung Foundation (2015-0438), and the Swedish Council for Health, Working Life and Welfare (FORTE; 2013-0325).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John and Sattar, Professor Naveed
• Authors: Robertson, J., Schaufelberger, M., Lindgren, M., Adiels, M., Schiöler, L., Torén, K., McMurray, J., Sattar, N., Åberg, M., and Rosengren, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation
• Publisher: American Heart Association
• ISSN: 0009-7322
• ISSN (Online): 1524-4539
• Published Online: 28 May 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Circulation 140:117-125
• Publisher Policy: Reproduced under a Creative Commons License