Association between adiposity and cardiovascular outcomes: an umbrella review and meta-analysis of observational and Mendelian randomization studies

Figures

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  Figure 1. Flow diagram of the study search and selection process.

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  Figure 2. Collective results of observational studies. (A) Increased risk of cardiovascular events with elevated continuous and categorical body mass index. (B) Increased risk of death with elevated continuous body mass index. All results are based on random-effect models. The cohort and participant columns display the number of independent cohorts and the total number of participants incorporated in the meta-analysis for the outcome. The certainty of evidence underlying each association between body mass index and cardiovascular outcomes was evaluated using the GRADE framework. BMI, body mass index; ES, effect size; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; HR, hazard ratio; OR, odds ratio; RR, risk ratio or relative risk.

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  Figure 3. Collective results of Mendelian randomization studies. (A) Increased risk of cardiovascular events per 1 kg/m2 increase in body mass index. (B) Increased risk of cardiovascular events per 5 kg/m2 increase in body mass index. (C) Increased risk of death per 1 kg/m2 increase in body mass index. All results are based on random-effects models. The cohort and cases columns display the number of independent cohorts and the number of cases incorporated in the meta-analysis for the outcome. BMI, body mass index; ES, effect size; HR, hazard ratio; OR, odds ratio; RR, risk ratio or relative risk.

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  Figure 4. Subgroup analyses of risk of cardiovascular diseases for central adiposity (A), categorical body mass index (B), and sex (C). All results are based on random-effects models. The cohort and participant columns display the number of independent cohorts and the total number of participants incorporated in the meta-analysis for the outcome. The certainty of evidence was evaluated using the GRADE framework. BMI, body mass index; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; RR, risk ratio or relative risk.

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  Figure 5. Risks of cardiovascular incidences and mortalities were re-analysed according to regions. BMI, body mass index; CVD, cardiovascular disease; CHD, coronary heart disease; ES, effect size; HR, hazard ratio; OR, odds ratio; RR, risk ratio or relative risk.