Does Body Mass Index Impact on the Relationship Between Systolic Blood Pressure and Cardiovascular Disease?

Key PointsQuestionWhat is the role of body mass index, systolic blood pressure and smoking in mediating the effect of education on cardiovascular disease risk?FindingWe find consistent evidence that body mass index, systolic blood pressure and smoking mediate the effect of education, explaining up to 18%, 27% and 33% respectively. Including all three risk factors in a model together explains around 40% of the effect of education.MeaningIntervening on body mass index, systolic blood pressure and smoking would lead to reductions in cases of CVD attributable to lower levels of education. Over half of the effect of education on risk of cardiovascular disease is not mediated through these risk factors.ImportanceLower levels of education are causally related to higher cardiovascular risk, but the extent to which this is driven by modifiable risk factors also associated with education is unknown.ObjectiveTo investigate the role of body mass index, systolic blood pressure and smoking in explaining the effect of education on risk of cardiovascular disease outcomes.DesignMultivariable regression analysis of observational data and Mendelian randomization (MR) analysis of genetic data.SettingUK Biobank and international genome-wide association study consortia.ParticipantsPredominantly individuals of European ancestry.Main outcomes and measuresThe effects of education (per 1-standard deviation increase, equivalent to 3.6 years) on coronary heart disease, cardiovascular disease (all subtypes), myocardial infarction and stroke risk (all measured in odds ratio, OR), and the degree to which this is mediated through body mass index, systolic blood pressure and smoking.ResultsEach additional standard deviation of education associated with 13% lower risk of coronary heart disease (OR 0.87, 95% confidence interval [CI] 0.84 to 0.89) in observational analysis and 37% lower risk (OR 0.63, 95% CI 0.60 to 0.67) in Mendelian randomization analysis. As a proportion of the total risk reduction, body mass index mediated 15% (95% CI 13% to 17%) and 18% (95% CI 14% to 23%) in the observational and Mendelian randomization estimates, respectively. Corresponding estimates for systolic blood pressure were 11% (95% CI 9% to 13%) and 21% (95% CI 15% to 27%), and for smoking, 19% (15% to 22%) and 33% (95% CI 17% to 49%). All three risk factors combined mediated 42% (95% CI 36% to 48%) and 36% (95 % CI 16% to 63%) of the effect of education on coronary heart disease in observational and Mendelian randomization respectively. Similar results were obtained when investigating risk of stroke, myocardial infarction and all-cause cardiovascular disease.Conclusions and relevanceBMI, SBP and smoking mediate a substantial proportion of the protective effect of education on risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of CVD attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.

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Risk factors mediating the effect of body-mass index and waist-to-hip ratio on cardiovascular outcomes: Mendelian randomization analysis

10.1101/2020.07.15.20154096 ◽

2020 ◽

Author(s):

Dipender Gill ◽

Verena Zuber ◽

Jesse Dawson ◽

Jonathan Pearson-Stuttard ◽

Alice R Carter ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Body Mass Index ◽

Body Mass ◽

European Ancestry ◽

Standard Deviation Increase ◽

Waist To Hip Ratio ◽

Increased Risk ◽

Artery Disease

Background: Higher body-mass index (BMI) and waist-to-hip ratio (WHR) increase the risk of cardiovascular disease, but the extent to which this is mediated by blood pressure, diabetes, lipid traits and smoking is not fully understood. Methods: Using consortia and UK Biobank genetic association summary data from 140,595 to 898,130 participants predominantly of European ancestry, MR mediation analysis was performed to investigate the degree to which genetically predicted systolic blood pressure (SBP), diabetes, lipid traits and smoking mediated an effect of genetically predicted BMI and WHR on risk of coronary artery disease (CAD), peripheral artery disease (PAD) and stroke. Results: The 49% (95% confidence interval [CI] 39%-60%) increased risk of CAD conferred per 1-standard deviation increase in genetically predicted BMI attenuated to 34% (95% CI 24%-45%) after adjusting for genetically predicted SBP, to 27% (95% CI 17%-37%) after adjusting for genetically predicted diabetes, to 47% (95% CI 36%-59%) after adjusting for genetically predicted lipids, and to 46% (95% CI 34%-58%) after adjusting for genetically predicted smoking. Adjusting for all the mediators together, the increased risk attenuated to 14% (95% CI 4%-26%). A similar pattern of attenuation was observed when considering genetically predicted WHR as the exposure, and PAD or stroke as the outcomes. Conclusions: Measures to reduce obesity will lower risk of cardiovascular disease primarily by impacting on downstream metabolic risk factors, particularly diabetes and hypertension. Reduction of obesity prevalence alongside control and management of its mediators is likely to be most effective for minimizing the burden of obesity.

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Relation Between Preclinical Atherosclerosis and Venous Thromboembolism in Patients With Thrombophilias – Longitudinal Study

Physiological Research ◽

10.33549/physiolres.932879 ◽

2014 ◽

pp. S403-S409 ◽

Cited By ~ 1

Author(s):

O. AUZKÝ ◽

R. DEMBOVSKÁ ◽

J. MRÁZKOVÁ ◽

Š. NOVÁKOVÁ ◽

L. PAGÁČOVÁ ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Longitudinal Study ◽

Venous Thromboembolism ◽

Waist Circumference ◽

Systolic Blood Pressure ◽

Body Mass ◽

History Of ◽

Preclinical Atherosclerosis

Preclinical atherosclerosis may represent a risk factor for venous thromboembolism (VTE). In longitudinal study we followed longitudinally 96 patients (32 men) with thrombophilias with (n=51) and without (n=45) history of VTE. In both groups we studied the changes of preclinical atherosclerosis at peripherally located arteries detected by ultrasound. In addition, we assessed changes in selected risk factors of atherosclerosis. During the mean follow-up of 56.0±7.62 months we did not find significant change in preclinical atherosclerosis defined as Belcaro score in either group (–3 % in the VTE group vs 0 % in non VTE group). Significant increase in body mass index (1.03±1.98 kg*m-2, resp. 1.21±1.67 kg*m-2, p<0.01) and non-significant increase in systolic blood pressure were detected in both groups. Waist circumference increased significantly only in patients without VTE (4.11±7.84 cm, p<0.05). No differences in changes of risk factors under study between both groups were detected. In summary, patients with thrombophilia and history of VTE showed no evidence of greater progression of atherosclerosis or increase in traditional risk factors of atherosclerosis than patients with thrombophilia without history of VTE. Unfavorable changes of body mass index, waist circumference and systolic blood pressure were detected in both groups during study period.

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Differences in Blood Pressure Level and Hypertension in Three Ethnic Groups of Northeastern India

Asia Pacific Journal of Public Health ◽

10.1177/101053950001200204 ◽

2000 ◽

Vol 12 (2) ◽

pp. 71-78 ◽

Cited By ~ 10

Author(s):

N.C. Hazarika ◽

D. Biswas ◽

K. Narain ◽

R.K. Phukan ◽

H.C. Kalita ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Waist Circumference ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Ethnic Groups ◽

Body Mass ◽

Alcohol Intake ◽

Blood Pressure Level ◽

Tea Garden

A cross sectional study on hypertension was done on 294 subjects aged 30 years and above. 150 households were selected randomly representing 50 households from each locality inhabited exclusively by the rural Mizos, indigenous rural Assamese and the tea-garden workers respectively, in the northeastern region of India. Blood pressure was measured by sphygmo-manorneter in sitting posture. Anthro-pometric measurements were taken using standard procedure for measuring height, weight, waist and hip girth. Information on age, sex, ethnicity, literacy, alcohol intake, smoking pattern, physical activity, occupation, amount of salt consumption was collected using a standard and pre-tested questionnaire. Significant differences were observed in both the systolic and diastolic blood pressure levels among the three different ethnic groups selected for this study ( p<0.0001). Multiple regression analyses indicated that in Mizos, age, waist circumference and alcohol intake were independently associated with increase in systolic blood pressure whereas smoking was found to be negatively associated with systolic blood pressure ( R2=0.391, p<0.001). Factors, which were the best predictors of diastolic blood pressure, were age and body mass index [(kg/m2) ( R2=0.227, p<0.001)]. In the rural Assamese population, the best predictors of systolic blood pressure were age and waist circumference ( R2=0.263, p=0.018). For the diastolic blood pressure, age, alcohol intake and body mass index were important correlates ( R2 = 0.131, p<0.001). In the tea garden community, important predictors of systolic blood pressure were age, gender and marital status ( R2=0.187, p<0.001). On the other hand, age and alcohol intake were best predictors for diastolic blood pressure ( R2=0.09, p<0.001). Asia Pac J Public Health 2000,-12(2): 71-78

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The Rate of Increase in Blood Pressure in Children 5 Years of Age Is Related to Changes in Aerobic Fitness and Body Mass Index

PEDIATRICS ◽

10.1542/peds.94.4.465 ◽

1994 ◽

Vol 94 (4) ◽

pp. 465-470

Author(s):

Steven Shea ◽

Charles E. Basch ◽

Bernard Gutin ◽

Aryeh D. Stein ◽

Isobel R. Contento ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Body Mass ◽

Aerobic Fitness ◽

Medical Center ◽

Multiple Regression Model ◽

Age Related ◽

Rate Of Increase

Objective. To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children. Study design. Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19:7 months. Aerobic fitness was assessed using a treadmill All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study. Setting. An inner-city medical center. Outcome measures. Blood pressure was measured using an automated Dinamap device. Results. Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P < .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02) Conclusion. Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.

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Consistency between Self-Reported and Recorded Values for Clinical Measures

Cardiology Research and Practice ◽

10.1155/2016/4364761 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Joseph Thomas III ◽

Mindy Paulet ◽

Jigar R. Rajpura

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Body Mass ◽

Pearson Correlation ◽

Recorded Data ◽

Pearson Correlation Analysis ◽

Reported Data ◽

Clinical Measures

Objectives. This study evaluated consistency between self-reported values for clinical measures and recorded clinical measures.Methods. Self-reported values were collected for the clinical measures: systolic blood pressure, diastolic blood pressure, glucose level, height, weight, and cholesterol from health risk assessments completed by enrollees in a privately insured cohort. Body mass index (BMI) was computed from reported height and weight. Practitioner recorded values for the clinical measures were obtained from health screenings. We used bivariate Pearson correlation analysis and descriptive statistics to evaluate consistency between self-reported data and recorded clinic measurements.Results. There was high correlation between self-reported clinical values and recorded clinical measures for diastolic blood pressure (r=0.91,P=<0.0001), systolic blood pressure (r=0.93,P=<0.0001), cholesterol (r=0.97,P=<0.0001), body mass index (r=0.96,P=<0.0001), glucose (r=0.96,P=<0.0001), weight (r=0.98,P=<0.0001), and height (r=0.89,P=<0.0001).Conclusions. Self-reported clinical values for each of the eight clinical measures examined had good consistency with practitioner recorded data.

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