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)

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: Gill, Professor Jason and Anderson, Dr Jana and Nelson, Professor Scott and Mackay, Professor Daniel and Welsh, Professor Paul and Celis, Dr Carlos and Gray, Professor Stuart and Iliodromiti, Dr Stamatina and Pell, Professor Jill 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 > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & 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

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
61777	1	BHF centre of excellence	Rhian Touyz	British Heart Foundation (BHF)	RE/13/5/30177	RI CARDIOVASCULAR & MEDICAL SCIENCES
60315	1	EMIF	Naveed Sattar	European Commission (EC)	115372	RI CARDIOVASCULAR & MEDICAL SCIENCES
69509	1	Women's reproductive health and its relation to diabetes and cardiovascular health	Stamatina Iliodromiti	Medical Research Council (MRC)	MR/N015177/1	MVLS MED - REPRODUCTIVE & MATERNAL MED