Physicians' Academy for Cardiovascular Education

New data challenge the obesity paradox with regard to CVD morbidity and longevity

Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity

Literature - Khan SS, Ning H, Wilkins JT, et al. - JAMA Cardiol 2018; published online ahead of print


High body mass index (BMI) has been associated with similar or lower all-cause mortality rates compared with normal BMI, but the contribution of CVD to these results is not clear [1,2].

In this study, lifetime risk estimates of incident total CVD and subtypes of CVD, as well as years lived with and without CVD, were calculated by weight status.

Adults aged 20-89 years, without CVD at baseline, with available BMI and outcomes data, as well as a follow-up of at least 10 years, who were included in the Cardiovascular Disease Lifetime Risk Pooling Project [3] were eligible for the analysis, resulting into 190,672 person-examinations across the life course, with 3.2 million person-years of follow-up until 2015.

Participants were stratified by index age groups (young: 20-39 years, middle-aged: 40-59 years, older: 60-79 years), gender and BMI strata (underweight: <18.5), normal: 18.5-24.9, overweight: 25.0-29.9, obesity: 30.0-39.9, morbid obesity: ≥40). The non-fatal CVD events of interest included myocardial infarction (MI), stroke, and heart failure (HF), and fatal events were stratified as death caused by CVD, coronary heart disease (CHD), or non-CVD events.

Main results


Overweight and obese individuals have a significantly increased long-term risk for CVD morbidity, a similar or shorter total longevity, and a greater proportion of life lived with morbidity compared with individuals with a normal BMI. These findings challenge the view that overweight is associated with greater longevity compared with normal BMI.


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