Key result
Obesity increased the risk of atherosclerotic cardiovascular disease (HR 1.30) and heart failure (HR 2.04), with the excess ASCVD risk largely mediated by renal function, blood pressure, triglycerides, and hyperglycemia.
Why the study?
Obesity is causally linked to cardiovascular outcomes but population control measures are limited, leaving unclear how much excess ASCVD and HF risk is explained by conventional risk factors.
Does obesity increase the risk of ASCVD and heart failure, and to what extent is this mediated by conventional risk factors?
Cohort (n=404,332)
Yes
Does obesity increase the risk of ASCVD and heart failure, and to what extent is this mediated by conventional risk factors?
Hazard Ratio: 1.3 (95% CI 1.26–1.35)
p-value: p=<0.0001
While conventional risk factors mediate a large proportion of the excess ASCVD risk associated with obesity, the excess heart failure risk is largely unexplained by these factors and requires direct weight management.
Obesity is causally associated with multiple cardiovascular outcomes but effective population measure to control obesity is limited. This study aims to decipher to which extent excess atherosclerotic cardiovascular diseases (ASCVD) and heart failure (HF) risk due to obesity can be explained by conventional risk factors. This is a prospective cohort study of 404,332 White UK Biobank participants. Participants with prior CVDs or other chronic diseases at baseline, or body mass index <18.5 kg/m2 were excluded. Data were collected at the baseline assessment between 2006 and 2010. Linkage to death registrations and hospital admission records was used to ascertain ASCVD and HF outcomes up to late 2021. Obesity was defined as body mass index ≥30 kg/m2. Candidate mediators included lipids, blood pressure (BP), glycated hemoglobin (HbA1c), and liver and kidney function markers, which were chosen based on clinical trials and Mendelian randomization studies. Cox proportional hazard models were used to estimate hazard ratios (HR) and their 95% confidence intervals (CIs). Mediation analysis based on g-formula was used to separately estimate the relative importance of mediators for ASCVD and HF. Compared with people without obesity, obese people had an increased risk of ASCVD (HR 1.30, 95% CI, 1.26-1.35) and HF (HR 2.04, 95% CI, 1.96-2.13) after adjusting for sociodemographic and lifestyle factors and medications for cholesterol, BP and insulin. The strongest mediators for ASCVD were renal function (eGFR: mediation proportion: 44.6%), BP (SBP: 24.4%; DBP: 31.1%), triglycerides (19.6%), and hyperglycemia (HbA1c 18.9%). These mediators collectively explained more excess risk of ASCVD than that of HF. Interventions that help obese individuals to maintain healthy lipid concentrations, BP, glycemic control, and kidney function could potentially alleviate a sizable proportion of the ASCVD burden. However, HF burden could not be meaningfully reduced without weight management.
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Zhou et al. (2023) conducted a cohort in Obesity (n=404,332). Obesity vs. Non-obese (BMI < 30 kg/m2) was evaluated on Incident atherosclerotic cardiovascular disease (ASCVD) (HR 1.30, 95% CI 1.26-1.35, p=<0.0001). Obesity increased the risk of atherosclerotic cardiovascular disease (HR 1.30) and heart failure (HR 2.04), with the excess ASCVD risk largely mediated by renal function, blood pressure, triglycerides, and hyperglycemia.
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