Key result
Current waist circumference was significantly associated with incident coronary heart disease (HR 1.13; 95% CI 1.03-1.23) even after adjustment for obesity mediators.
Why the study?
Do different weight histories (cumulative excess weight, waist circumference, BMI) predict incident coronary heart disease and stroke in adults aged ≥40 years?
Cohort (n=4,398)
Do different weight histories (cumulative excess weight, waist circumference, BMI) predict incident coronary heart disease and stroke in adults aged ≥40 years?
Current and maximum waist circumference are significant predictors of incident coronary heart disease and stroke, even after adjusting for obesity mediators, whereas cumulative excess weight confers little additional risk.
Cumulative adiposity histories may aid CHD/stroke risk stratification; leaves open incremental value beyond current BMI in clinical models.
BACKGROUND: This study aimed to determine the association between different weight histories, including cumulative excess weight, cumulative excess waist circumference (WC), duration of general and central adiposity, current and maximum body mass index, and current and maximum WC, and incident coronary heart disease (CHD) and stroke. METHODS AND RESULTS: The study population consisted of 4398 adults aged ≥40 years without CHD or stroke at baseline. Associations between different weight histories and CHD and stroke were determined by multivariable time-varying Cox regression models after adjustment for age, sex, and time-varying confounders. Further adjustment was also done for mediators (eg, diabetes mellitus, hypercholesterolemia, and hypertension). During median follow-up of 13.9 years, 718 incident CHD and 158 stroke events were documented. Multivariable adjusted hazard ratios (HRs) were calculated in the sex and confounder adjusted model for CHD per 1-SD increase in cumulative excess weight (HR: 1.02; 95% confidence interval [CI], 0.96-1.07), cumulative excess WC (HR: 1.14; 95% CI, 1.04-1.24), duration of general adiposity (HR: 1.00; 95% CI, 0.92-1.08), duration of central adiposity (HR: 1.01; 95% CI, 0.93-1.09), current body mass index (HR: 1.03; 95% CI, 0.99-1.07), current WC (HR: 1.21; 95% CI, 1.11-1.32), maximum body mass index (HR: 1.01; 95% CI, 0.95-1.07), and maximum WC (HR: 1.17; 95% CI, 1.07-1.28). After further adjustment for mediators, current and maximum WC still showed a significant risk (HR: 1.13 [95% CI, 1.03-1.23] and 1.09 [95% CI, 1.00-1.20], respectively). Moreover, in the sex and confounder adjusted model, cumulative excess WC and maximum WC were associated with higher risk of stroke (hazard ratio: 1.21 [95% CI, 0.99-1.48] and 1.25 [95% CI, 1.02-1.55], respectively). CONCLUSIONS: Exposure to cumulative excess weight and cumulative excess WC confers little additional risk beyond their current and maximum values. Even current and maximum WC were associated with incident CHD in the presence of obesity mediators, and the latter was a significant predictor of stroke in the presence of confounders.
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Kabootari et al. (2018) conducted a cohort in Incident coronary heart disease and stroke (n=4,398). Weight histories (including cumulative excess weight and waist circumference) was evaluated on Incident coronary heart disease (CHD) (HR 1.13, 95% CI 1.03-1.23). Current waist circumference was significantly associated with incident coronary heart disease (HR 1.13; 95% CI 1.03-1.23) even after adjustment for obesity mediators.
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