Sex and Body Mass Index differences in the incidence of vascular and cardiometabolic diseases: A retrospective cohort study including 233 730 patients in Germany

Aims To examine the association between elevated body mass index (BMI) and a wide range of vascular and cardiometabolic diseases in men and women. Materials and Methods This retrospective cohort study used data from the IQVIA Disease Analyzer database, comprising anonymized records from over 3000 office‐based physicians in Germany. We included 233 730 patients aged ≥40 years with at least one recorded BMI measurement between January 2005 and December 2023. Fourteen vascular and cardiovascular conditions were identified using ICD‐10 codes. Ten‐year cumulative incidence was estimated using the Kaplan–Meier method, and Cox regression models assessed associations between BMI groups and disease risk. Results Obesity was associated with higher risks of heart failure (HR: 1.95; 95% CI: 1.85–2.05), pulmonary embolism (HR: 1.83; 95% CI: 1.62–2.07), atrial fibrillation/flutter (HR: 1.63; 95% CI: 1.55–1.72), phlebitis/vein thrombosis (HR: 1.60; 95% CI: 1.51–1.70), varicose veins of the lower extremities (HR: 1.57; 95% CI: 1.51–1.64), angina pectoris (HR: 1.30; 95% CI: 1.21–1.41), and myocardial infarction (HR: 1.26; 95% CI: 1.15–1.38), but a lower risk of haemorrhagic stroke (HR: 0.76; 95% CI: 0.62–0.93). Sex‐specific analyses revealed stronger associations in men for heart failure, angina pectoris, and atrial fibrillation, while women showed stronger links to pulmonary embolism, phlebitis/vein thrombosis, myocardial infarction, and varicose veins. Notably, obesity was associated with a 26% lower risk of aortic aneurysm (thoracic or abdominal) in women, with no significant effect in men. Conclusions Obesity is associated with an increased risk of vascular and cardiometabolic diseases. The strength and direction of associations show some variation between men and women, but these tendencies should be interpreted with caution.