Key result
Highest cumulative excess BMI linked to ~60% greater MI and stroke risk in younger adults.
Why the study?
While obesity at a given point in time is a known cardiovascular risk factor, the contribution of long-term excess weight exposure to cardiovascular risk has not been well established.
Does higher cumulative excess weight exposure over time increase the risk of fatal and non-fatal MI and stroke in adults with BMI > 25 kg/m2?
Cohort (n=136,498)
Does higher cumulative excess weight exposure over time increase the risk of fatal and non-fatal MI and stroke in adults with BMI > 25 kg/m2?
Long-term cumulative excess weight exposure is a stronger predictor of cardiovascular risk than a single point-in-time BMI measurement, particularly in younger individuals.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“presence of obesity at a particular point in their life is not the final sentence, but a call to action. If that individual decreases their weight and thus reduces their long-term excess weight exposure, their cardiovascular risk might decrease.”
“Excess weight at any given point in time is not a life sentence. What happens to someone's weight over long periods of time matters more for heart health. Our study suggests that if a person lowers their weight, their health outcomes can improve.”
“Excess weight at a given point in time does not seal one's fate. What has a greater impact is what is done about it next, over time.”
Supports assessing cumulative excess BMI to refine CV risk in younger adults; extends evidence that long-term exposure outperforms point measurements.
Background Obesity at a given point in time is a known cardiovascular risk factor. However, the contribution of long-term excess weight exposure to cardiovascular risk has not been well established. We therefore conducted a study to evaluate the relationship between long-term excess weight exposure and incidence of cardiovascular events. Methods This secondary analysis of a prospective cohort study analyzed data from adult participants in Nurses’ Health Study and Health Professionals Follow-Up Study with a BMI > 25 kg/m 2 between 01/01/1990 and 12/31/1999. We investigated the relationship between cumulative exposure to body mass index (BMI) > 25 kg/m 2 between 1990 and 1999 and time to the composite primary outcome of fatal and non-fatal myocardial infarction (MI) and stroke beginning in 2000. Results The mean baseline BMI of 136,498 study participants was 27.2 kg/m 2 and the mean annualized cumulative excess BMI exposure was 3.9 kg/m 2 . In multivariable analysis having annualized cumulative excess BMI in the 4 th vs. 1 st quartiles was associated with an increased cardiovascular risk for women aged < 35 (HR 1.60; 95% CI 1.05–2.44) and 35−50 years (HR 1.27; 95% CI 1.01–1.58); and for men aged 35−50 (HR 1.57; 95% CI 1.22–2.03) and 50−65 (HR 1.23; 95% CI 1.02–1.48). There was no increase in cardiovascular risk with greater excess BMI exposure for women older than 50 and for men older than 65. Baseline BMI (in 1990) was not associated with cardiovascular risk in models adjusted for cumulative excess BMI exposure. Conclusion Long-term excess weight exposure plays a greater role in cardiovascular risk than weight at a single point in time. This risk is strongest in younger individuals.
Turchin et al. (2026) conducted a cohort in Excess weight (BMI > 25 kg/m2) (n=136,498). Cumulative excess BMI exposure (4th quartile) vs. Cumulative excess BMI exposure (1st quartile) was evaluated on Composite of fatal and non-fatal myocardial infarction (MI) and stroke (HR 1.60 (women < 35 years), 95% CI 1.05-2.44). Cumulative excess BMI exposure in the highest versus lowest quartile increased the risk of MI and stroke in women <35 years (HR 1.60; 95% CI 1.05-2.44) and men 35-50 years (HR 1.57; 95% CI 1.22-2.03).
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