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 MorbidityLiterature - Khan SS, Ning H, Wilkins JT, et al. - JAMA Cardiol 2018; published online ahead of print
- Incident CVD events occurred in more middle-aged men and women in the overweight (37% and 28%, respectively), obese (47% and 39%), and morbidly obese (65% and 48%) strata compared with adults in the normal BMI group (32% and 22%).
- Compared with normal BMI, middle-aged men and women who were overweight, obese, and morbidly obese had significantly higher HRs for incident CVD events (HR for overweight men: 1.21; 95%CI: 1.14-1.28; HR for overweight women: 1.32; 95%CI: 1.24-1.40; HR for obese men: 1.67; 95%CI: 1.55-1.79; HR for obese women: 1.85; 95%CI: 1.72-1.99; HR for morbidly obese men: 3.14; 95%CI: 2.48-3.97; HR for morbidly obese women: 2.53; 95%CI: 2.20-2.91).
- The adjusted competing HRs of incident CVD events per unit of BMI in middle-aged men and women were 1.05 (95%CI: 1.05-1.06) and 1.05 (95%CI: 1.04-1.05), respectively.
- In middle-aged men, overall survival time was similar in the normal BMI (29.1 years) and overweight (29.3 years) groups, and was significantly shorter in the obese (27.2 years) and morbidly obese (23.4 years) groups.
- In middle-aged women, overall survival was longest in the normal BMI category (33.2 years) compared with women in higher BMI categories (overweight: 31.8 years; obese: 29.8 years; and morbidly obese: 27.2).
- Average years lived with CVD in middle-aged men and women were shortest in the normal BMI group compared to individuals in the higher BMI groups, resulting in relative compression of CV morbidity. Normal BMI significantly delayed incidence of CVD in middle-aged men and women by 7.5 and 7.1 years, respectively, compared with morbid obesity.
- For all findings, similar patterns were seen in younger and older men and women.
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.