Adiposity in Adults and Life Expectancy with and without Cardiovascular Disease. The Doetinchem Cohort Study

Background: While life expectancy (LE) in the Netherlands has increased over recent decades, it is not always accompanied by good health, particularly among individuals with adiposity. As adiposity is a major risk factor for cardiovascular disease (CVD), previous studies have explored its association with LE and CVD burden, but findings remain heterogeneous. Objective: To assess the association between adiposity and LE in adults, with and without CVD. Methods: We used data from the longitudinal Doetinchem Cohort Study (DCS), including 2,323 participants aged 50-70 years (49% women). Adiposity categories were determined (low, increased, high and very high) based on the combination of body mass index (BMI) and waist circumference (WC) thresholds for overweight and obesity based on the AACE/ACE definitions. CVD and mortality were assessed via linkage to hospital and death registries. A multistate life table approach estimated total and CVD-specific LE using transition rates between three health states-CVD-free to CVD, CVD-free to death, and CVD to death-incorporating prevalences and adjusted hazard ratios (HRs) for adiposity categories by sex and CVD status. Results: LE did not differ between adiposity categories at age 50 in both men and women. Men with very high adiposity had a 2.6-year lower LE free of CVD compared to men in the low adiposity category (difference: -2.6 years, 95% CI: -3.6, -1.5), and lived more years with CVD (difference: 2 years, 95% CI: 0.9, 2.9). Men in any adiposity category lived more years with CVD than women in a similar category. In women, there were no differences in CVD-specific LE between the adiposity categories. Conclusion: Men in the very high adiposity category lived more years with CVD compared to those in the low category. These findings highlight the need for targeted cardiovascular prevention in men with very high adiposity to delay CVD onset and promote a healthy lifespan.