Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK

Iyen, Barbara; Weng, Stephen; Vinogradova, Yana; Akyea, Ralph K; Qureshi, Nadeem; Kai, Joe

Abstract

Background: Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified.

Methods: This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes.

Results: 264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8kg/m2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06kg/m2 (± 3.8)). Compared with overweight individuals, class-3 obese individuals had hazards ratios (HR) of 3.26 (95% CI 2.98-3.57) for heart failure, HR of 2.72 (2.58-2.87) for all-cause mortality and HR of 3.31 (2.84-3.86) for CVD-related mortality, after adjusting for baseline demographic and cardiovascular risk factors.

Conclusion: The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.

Citation

Iyen, B., Weng, S., Vinogradova, Y., Akyea, R. K., Qureshi, N., & Kai, J. (2021). Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK. BMC Public Health, 21, Article 576. https://doi.org/10.1186/s12889-021-10606-1

• Journal Article Type: Article
• Acceptance Date: Mar 10, 2021
• Online Publication Date: Apr 15, 2021
• Publication Date: Apr 15, 2021
• Deposit Date: Mar 17, 2021
• Publicly Available Date: Apr 20, 2021
• Journal: BMC Public Health
• Electronic ISSN: 1471-2458
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Article Number: 576
• DOI: https://doi.org/10.1186/s12889-021-10606-1
• Keywords: Obesity, overweight, body mass index (BMI), BMI trajectory, cardiovascular disease, heart failure
• Public URL: https://nottingham-repository.worktribe.com/output/4901861
• Publisher URL: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10606-1