In patients with CVD, waist circumference per SD increase raised composite risk of recurrent CVE, T2D, cancer by 25% (HR 1.25) and predicted shorter disease-free survival.
Do higher adiposity measures increase the risk of a composite of recurrent cardiovascular events, type 2 diabetes, and cancer in patients with established cardiovascular disease?
In patients with established CVD, higher adiposity measures (WC, BMI, WtHR, VAT) are associated with an increased risk of a composite of recurrent cardiovascular events, type 2 diabetes, and cancer, leading to shorter disease-free survival.
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Abstract Background Excess adiposity, particularly visceral adiposity, may contribute to various diseases, including cardiovascular events (CVE), type 2 diabetes (T2D) and cancer. Adiposity measures reflecting visceral adiposity may have a stronger relation to these diseases than adiposity measures reflecting overall adiposity. Existing studies focus on the relation between individual adiposity measures and the risk of individual diseases. However, prevention of morbidity asks for establishing the risk of a combined endpoint of multiple diseases, particularly in patients with established cardiovascular disease (CVD), who have a heightened risk of recurrent CVE, T2D and cancer. Purpose To quantify the relation between waist circumference (WC), body mass index (BMI), waist to height ratio (WtHR), radiologically measured abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), and the risk of the composite of recurrent CVE, T2D and cancer, as well as the individual outcomes and all-cause mortality in patients with established CVD. Methods Patients with CVD (n=6,138) were included from a prospective cohort study. Anthropometric and ultrasound measurements of abdominal adipose tissue were done by trained staff at baseline. Cox proportional hazard models adjusted for age, sex, smoking and education level were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the relation between each adiposity measure and the composite outcome, its components and all-cause mortality. Kaplan-Meier curves in sex-stratified quartiles with age on the time-scale illustrated disease-free survival. Results Over 10.3 year follow-up (IQR: 6.2-14.9 years), 2,259 patients (40 /1,000 PY) experienced the composite outcome: 18% recurrent CVE, 10% T2D and 15% cancer. All adiposity measures except SAT were related to a higher risk of the composite outcome. This relation was strong for WC (HR per SD increase 1.25, 95% CI 1.19-1.31), WtHR (HR 1.23, 95% CI 1.17-1.28), VAT (HR 1.24, 95% CI 1.19-1.30) and BMI (HR 1.19, 95% CI 1.14-1.24). However, only WC was related to higher risks of recurrent CVE and WC and VAT to all-cause mortality. Individuals in the highest quartile of each adiposity measure compared to individuals in the lowest quartile had a shorter median disease-free survival for the composite outcome, ranging from 2.7 years for WtHR to 5.4 years for BMI. Conclusion In patients with established CVD, all adiposity measures except SAT were related to the composite of recurrent CVE, T2D and cancer. Measurement of WC, BMI, WtHR and VAT can help identifying high-risk patients, allowing for earlier interventions. Future work is needed to assess whether incorporating these measures into prediction tools leads to improved clinical outcomes. Increases in all adiposity measures were related to shorter disease-free survival, underscoring the importance of addressing adiposity to preserve healthy life years in patients with CVD.
Bhattacharya et al. (Sat,) reported a other. In patients with CVD, waist circumference per SD increase raised composite risk of recurrent CVE, T2D, cancer by 25% (HR 1.25) and predicted shorter disease-free survival.