The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent

Published on May 1, 2018in European Heart Journal23.24
· DOI :10.1093/eurheartj/ehy057
Stamatina Iliodromiti15
Estimated H-index: 15
(Glas.: University of Glasgow),
Carlos Celis-Morales19
Estimated H-index: 19
(Glas.: University of Glasgow)
+ 8 AuthorsNaveed Sattar115
Estimated H-index: 115
(Glas.: University of Glasgow)
Aims: The data regarding the associations of body mass index (BMI) with cardiovascular (CVD) risk, especially for those at the low categories of BMI, are conflicting. The aim of our study was to examine the associations of body composition (assessed by five different measures) with incident CVD outcomes in healthy individuals. Methods and results: A total of 296 535 participants (57.8% women) of white European descent without CVD at baseline from the UK biobank were included. Exposures were five different measures of adiposity. Fatal and non-fatal CVD events were the primary outcome. Low BMI (≤18.5 kg m−2) was associated with higher incidence of CVD and the lowest CVD risk was exhibited at BMI of 22–23 kg m−2 beyond, which the risk of CVD increased. This J-shaped association attenuated substantially in subgroup analyses, when we excluded participants with comorbidities. In contrast, the associations for the remaining adiposity measures were more linear; 1 SD increase in waist circumference was associated with a hazard ratio of 1.16 [95% confidence interval (CI) 1.13–1.19] for women and 1.10 (95% CI 1.08–1.13) for men with similar magnitude of associations for 1 SD increase in waist-to-hip ratio, waist-to-height ratio, and percentage body fat mass. Conclusion: Increasing adiposity has a detrimental association with CVD health in middle-aged men and women. The association of BMI with CVD appears more susceptible to confounding due to pre-existing comorbidities when compared with other adiposity measures. Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.
Figures & Tables
  • References (39)
  • Citations (21)
#1Dagfinn Aune (Imperial College London)H-Index: 37
#2Abhijit Sen (NTNU: Norwegian University of Science and Technology)H-Index: 11
Last.Lars J. Vatten (NTNU: Norwegian University of Science and Technology)H-Index: 83
view all 8 authors...
Cited By21
#1Guo-Chong Chen (Albert Einstein College of Medicine)
#2Rhonda Arthur (Albert Einstein College of Medicine)H-Index: 3
Last.Yangbo Sun (UI: University of Iowa)
view all 18 authors...
#1Lyn D. Ferguson (Glas.: University of Glasgow)H-Index: 4
#2Stefan Siebert (Glas.: University of Glasgow)H-Index: 17
Last.Naveed Sattar (Glas.: University of Glasgow)H-Index: 115
view all 4 authors...
View next paperBody mass index, waist circumference, and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82,864 participants from nine cohort studies