scholarly journals Obesity Duration, Severity, and Distribution Trajectories and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities Study

2021 ◽  
Author(s):  
Laura M. Raffield ◽  
Annie Green Howard ◽  
Misa Graff ◽  
Dan‐Yu Lin ◽  
Susan Cheng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Body Mass ◽  
Latent Class ◽  
Moderate Increase ◽  
Cvd Risk ◽  
Atherosclerosis Risk In Communities ◽  
Slow Decline ◽  
Atherosclerosis Risk

Background Research examining the role of obesity in cardiovascular disease (CVD) often fails to adequately consider heterogeneity in obesity severity, distribution, and duration. Methods and Results We here use multivariate latent class mixed models in the biracial Atherosclerosis Risk in Communities study (N=14 514; mean age=54 years; 55% female) to associate obesity subclasses (derived from body mass index, waist circumference, self‐reported weight at age 25, tricep skinfold, and calf circumference across up to four triennial visits) with total mortality, incident CVD, and CVD risk factors. We identified four obesity subclasses, summarized by their body mass index and waist circumference slope as decline (4.1%), stable/slow decline (67.8%), moderate increase (24.6%), and rapid increase (3.6%) subclasses. Compared with participants in the stable/slow decline subclass, the decline subclass was associated with elevated mortality (hazard ratio [HR] 1.45, 95% CI 1.31, 1.60, P <0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, P <0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, P =0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, P =0.0008), adjusting for baseline body mass index and CVD risk factor profile. The moderate increase latent class was not associated with any significant differences in CVD risk as compared to the stable/slow decline latent class and was associated with a lower overall risk of mortality (HR 0.85, 95% CI 0.80, 0.90, P <0.0001), despite higher body mass index at baseline. The rapid increase latent class was associated with a higher risk of heart failure versus the stable/slow decline latent class (HR 1.34, 95% CI 1.10, 1.62, P =0.004). Conclusions Consideration of heterogeneity and longitudinal changes in obesity measures is needed in clinical care for a more precision‐oriented view of CVD risk.

Abstract P172: Associations of Body Mass Index From Early-, Mid-, and Older- Adulthood With Incident Heart Failure and Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Michael J Fliotsos ◽  
Di Zhao ◽  
Chiadi Ndumele ◽  
Eliseo Guallar ◽  
Gregory L Burke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Body Mass Index ◽  
Body Mass ◽  
Clinical Encounter ◽  
Cvd Risk ◽  
Prognostic Information ◽  
Measured Weight ◽  
Increased Risk

Background: Obesity contributes significantly to increased risk of cardiovascular disease (CVD) and particularly heart failure (HF). However, an elevated body mass index (BMI) in older adults might not fully reflect the additional risk associated with excess weight at a younger age. We determined the prognostic value of self-reported weights from early- and mid-adulthood, after accounting for current weight, with incident HF and CVD. Methods: We studied 6,437 MESA participants (aged 45-84 years) with self-reported weights at ages 20 and 40 (by questionnaire) and measured weight at the baseline exam (2000-2002). BMI was calculated using measured height at baseline. Cox hazard models assessed relationships between BMI at each age with HF and CVD. Results: Participant mean age was 62±10 years and 53% were women. Over a median follow-up of 13 years, 290 HF and 828 CVD events occurred. Elevated BMI at each age point (age 20, age 40, and MESA baseline) was independently associated with HF, and to lesser extent with CVD ( Figure ). After adjustment for demographics, CVD risk factors, and baseline BMI, higher self-reported BMIs at ages 20 and 40 years were independently associated with increased risk of incident HF with hazard ratios (HR) 1.18 (95% CI 1.05-1.32) and 1.30 (1.15-1.46), respectively, per 1 SD higher BMI. Participants with self-reported obesity (BMI≥30) at age 20 [HR 3.20 (1.93-5.32)] and age 40 [HR 1.92 (1.31-2.83)] had greater HF risk, even after accounting for current BMI. For incident CVD, only higher self-reported BMI at age 20 (per 1 SD) was associated after accounting for current BMI [HR 1.09 (1.01-1.17)]. Conclusions: Assessment of self-reported lifetime weights is a simple tool utilized in any clinical encounter. Although subject to recall bias, self-reported weights provide prognostic information about future HF risk, incremental to current BMI, in a multi-ethnic cohort of middle-aged to older adults.

scholarly journals Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Barbara Iyen ◽  
Stephen Weng ◽  
Yana Vinogradova ◽  
Ralph K. Akyea ◽  
Nadeem Qureshi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Cohort Study ◽  
Body Mass ◽  
World Health ◽  
Obese Adults ◽  
Bmi Trajectories ◽  
The Impact

Abstract Background Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified. Methods This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes. Results 264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8 kg/m2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06 kg/m2 (± 3.8)). Compared with overweight individuals, class-3 obese individuals had hazards ratios (HR) of 3.26 (95% CI 2.98–3.57) for heart failure, HR of 2.72 (2.58–2.87) for all-cause mortality and HR of 3.31 (2.84–3.86) for CVD-related mortality, after adjusting for baseline demographic and cardiovascular risk factors. Conclusion The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.

Abstract MP013: Strong Inverse Relation between Physical Activity and Incidence of Cardiovascular Disease in African Americans: the Atherosclerosis Risk in Communities Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Elizabeth J Bell
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
African Americans ◽  
Risk Reduction ◽  
Atherosclerosis Risk In Communities ◽  
Baseline Visit ◽  
Atherosclerosis Risk

Introduction: Although there is substantial evidence that physical activity reduces risk of cardiovascular disease (CVD), the few studies that included African Americans offer inconclusive evidence and did not study stroke and heart failure separately. Objective: We examined, in African Americans and Caucasians in the Atherosclerosis Risk in Communities study (ARIC), the association of physical activity with CVD incidence (n=1,039) and its major components - stroke (n=350), heart failure (n=633), and coronary heart disease (n=442) - over a follow-up period of 21 years. Methods: ARIC is a population-based biracial cohort study of 45– to 64-yr-old adults at the baseline visit in 1987–89. Physical activity was assessed using the modified Baecke physical activity questionnaire and categorized by the American Heart Association’s ideal CVD health guidelines: poor, intermediate, and ideal physical activity. An incident CVD event was defined as the first occurrence of 1) heart failure, 2) definite or probable stroke, or 3) coronary heart disease, defined as a definite or probable myocardial infarction or definite fatal coronary heart disease. Results: We included 3,707 African Americans and 10,018 Caucasians free of CVD at the baseline visit. After adjustment for age, sex, cigarette smoking, alcohol intake, hormone therapy use, education, and ‘Western’ and ‘Prudent’ dietary pattern scores, higher physical activity was inversely related to CVD, heart failure, and coronary heart disease incidence in African Americans and Caucasians (p-values for trend tests <.0001), and with stroke in African Americans. Hazard ratios (95% confidence intervals) for CVD for intermediate and ideal physical activity, respectively, compared to poor, were similar by race: 0.65 (0.56, 0.75) and 0.59 (0.49, 0.71) for African Americans, and 0.74 (0.66, 0.83) and 0.67 (0.59, 0.75) for Caucasians (p-value for interaction = 0.38). Physical activity was also associated similarly in African Americans and Caucasians for each of the individual CVD outcomes (coronary heart disease, heart failure, and stroke), with an approximate one-third reduction in risk for intermediate and ideal physical activity versus poor physical activity- this reduction was statistically significant. Conclusions: In conclusion, our findings reinforce public health recommendations that regular physical activity is important for CVD risk reduction, including reductions in stroke and heart failure. They provide strong new evidence that this risk reduction applies to African Americans as well as Caucasians and support the idea that some physical activity is better than none.

Abstract P079: Alcohol Consumption and Risk of Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Xintong He ◽  
Natalie Daya ◽  
Casey M. Rebholz ◽  
Mariana Lazo ◽  
Elizabeth Selvin
Keyword(s):  
Body Mass Index ◽  
Alcohol Consumption ◽  
Body Mass ◽  
Lower Risk ◽  
Fasting Glucose ◽  
Diabetes Risk ◽  
Incident Diabetes ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

Background: Moderate alcohol consumption has been reported to be associated with lower risk for diabetes with some studies showing a U-shaped association. Whether and how the association might differ by gender or obesity status is controversial. Objective: To evaluate the prospective association between alcohol consumption and the long-term risk of diabetes in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: A prospective analysis of 11,263 ARIC participants without prevalent diabetes (55% women, 81%white, mean age 54 years). Alcohol consumption was assessed at visit 1 (1987-1989). Participants were followed-up for incident diabetes defined by fasting glucose more than 126 mg/dL, non-fasting glucose more than 200 mg/dL, self-reported diagnosis of diabetes or use of diabetic medication. We used Cox models to estimate hazard ratios of diabetes risk by drinking categories in women and men, respectively. Results: During a median follow-up of 21 years, there were 3518 incident diabetes cases. In the fully adjusted model, compared to never drinkers, among women, 7-14 drinks/week was associated with a significantly lower risk of diabetes; whereas among men, 14-21 drinks/week was associated with a significantly lower risk ( Table ). There was a significant interaction between drinking categories and smoking status or between drinking categories and body mass index in women. Among women, a U-shaped association was mainly present among non-smokers, and significant decreasing risk is only found among normal-weight and overweight participants, but not obese participants. Conclusion: Low levels of alcohol intake (1-2 drinks per day for women and 2-3 drinks per day for men) are inversely associated with diabetes risk. The association is modified by smoking and body mass index in women.

scholarly journals Epidemiology of Heart Failure Stages in Middle‐Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study

2021 ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Solomon K. Musani ◽  
Kunihiro Matsushita ◽  
Walter Beard ◽  
Olushola B. Obafemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Left Ventricular ◽  
Study Cohort ◽  
Atherosclerosis Risk In Communities ◽  
Cardiovascular Morbidity And Mortality ◽  
Atherosclerosis Risk

Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993–1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) Stage 0 : no risk factors; (2) Stage A : presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) Stage B : presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) Stage C/D : prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all‐cause mortality on follow‐up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow‐up (median 19.0 years), 309 participants developed overt HF, 390 incurred new‐onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person‐years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5‐ to 2‐fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community‐based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.

Abstract 14043: Association of Non-Alcoholic Steatohepatitis Assessed by Fib-4 Index and Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aliza Hussain ◽  
VIJAY NAMBI ◽  
Elizabeth Selvin ◽  
Wensheng Sun ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cox Regression ◽  
Advanced Fibrosis ◽  
Cvd Risk ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Aric Study ◽  
Cvd Mortality

Introduction: Cardiovascular disease (CVD) is the most common cause of death in nonalcoholic steatohepatitis (NASH). While these conditions share many cardio-metabolic risk factors including metabolic syndrome, diabetes and dyslipidemia, limited data exist on whether NASH is independently and prospectively associated with incident CVD beyond traditional risk factors. Fibrosis-4 (FIB-4) index is a scoring system based on platelet count, age, AST and ALT, shown to be comparable to magnetic resolution elastography for predicting advanced fibrosis in biopsy-proven NASH. We sought to evaluate the association of elevated FIB-4 with global CVD events and CVD mortality in the Atherosclerosis Risk in Communities (ARIC) Study Methods: We studied 5531 individuals, mean age of 76 (SD 5.2) years, 58% female, 22% black, at ARIC visit 5 (2011-2013). FIB-4 was categorized as low risk of advanced fibrosis for score <1.45, intermediate for 1.45-3.25 and high for >3.25. Cox regression was used to estimate the association of FIB-4 with time to first global CVD event (CHD, ischemic stroke or heart failure hospitalization) and CVD mortality adjusted for pooled cohort equation risk factors. Results: Over a median follow up of 6.2 (5.3-6.8) years, there were 1108 global CVD events and 457 CVD deaths. In adjusted models, compared to participants with low FIB-4 (<1.45), those with elevated FIB-4 >3.25, had significantly increased risk for global CVD events (HR 1.58, 95% CI 1.23-2.02) and CVD mortality (HR 1.70, 95% CI 1.16-2.50). Conclusions: In a large prospective cohort, presence of advanced liver fibrosis, as assessed by elevated FIB-4 index >3.25, was associated with increased risk for CVD events and CVD mortality, beyond traditional CVD risk factors. Future clinical trials of candidate medications under study for NASH should examine whether effective NASH treatment will impact CV outcomes.

scholarly journals Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index

2019 ◽  
Vol 40 (34) ◽  
pp. 2849-2855 ◽  
Author(s):  
Guo-Chong Chen ◽  
Rhonda Arthur ◽  
Neil M Iyengar ◽  
Victor Kamensky ◽  
Xiaonan Xue ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Postmenopausal Women ◽  
Body Mass ◽  
Body Fat ◽  
Normal Body Mass Index ◽  
Cvd Risk ◽  
Normal Body ◽  
Increased Risk ◽  
Regional Body Fat

Abstract Aims Central adiposity is associated with increased cardiovascular disease (CVD) risk, even among people with normal body mass index (BMI). We tested the hypothesis that regional body fat deposits (trunk or leg fat) are associated with altered risk of CVD among postmenopausal women with normal BMI. Methods and results We included 2683 postmenopausal women with normal BMI (18.5 to &lt;25 kg/m2) who participated in the Women’s Health Initiative and had no known CVD at baseline. Body composition was determined by dual energy X-ray absorptiometry. Incident CVD events including coronary heart disease and stroke were ascertained through February 2017. During a median 17.9 years of follow-up, 291 incident CVD cases occurred. After adjustment for demographic, lifestyle, and clinical risk factors, neither whole-body fat mass nor fat percentage was associated with CVD risk. Higher percent trunk fat was associated with increased risk of CVD [highest vs. lowest quartile hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.33–2.74; P-trend &lt;0.001], whereas higher percent leg fat was associated with decreased risk of CVD (highest vs. lowest quartile HR = 0.62, 95% CI 0.43–0.89; P-trend = 0.008). The association for trunk fat was attenuated yet remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher percent trunk fat combined with lower percent leg fat was associated with particularly high risk of CVD (HR comparing extreme groups = 3.33, 95% CI 1.46–7.62). Conclusion Among postmenopausal women with normal BMI, both elevated trunk fat and reduced leg fat are associated with increased risk of CVD.

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