Prospective Associations of Obesity and Obesity Severity With 9 Cardiovascular Outcomes
The Cross-Cohort Collaboration
This prospective cross-cohort analysis showed that not only obesity but particularly its severity is strongly predictive of multiple cardiovascular outcomes, with a graded relationship across the full BMI spectrum.
Summary
BACKGROUND:Obesity is an established risk factor for cardiovascular disease (CVD); however, the overall and sex-specific relationships across the full spectrum of body mass index (BMI), particularly severe obesity defined as class 2 (BMI 35 to <40.0 kg/m2) and class 3 (BMI ≥40 kg/m2), and long-term CVD outcomes remain incompletely described.METHODS:We included 289 875 participants (mean age, 60.3 years; 79.2% women) from 21 cohorts of the Cross-Cohort Collaboration enrolled between 1948 and 2015 with harmonized BMI data, a BMI ≥18.5 kg/m2, and at least one of nine adjudicated outcomes: time to first fatal and non-fatal myocardial infarction (MI), fatal and nonfatal stroke, heart failure (HF), atrial fibrillation (AF), total coronary heart disease (CHD), total CVD, CHD mortality, CVD mortality, and all-cause mortality. Multivariable Cox proportional hazard models with restricted cubic splines were used to estimate the hazard ratio (HR) of BMI for each outcome, adjusting for demog
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