Article

Although cardiovascular disease (CVD) is the biggest global cause of
death, CVD mortality is falling in developed countries. There is concern that
this trend may be offset by increasing levels of obesity.
DESIGN: We used the
Systematic Coronary Risk Evaluation (SCORE) data set to examine relationships
between body mass index (BMI), conventional risk factors and CVD mortality.
The SCORE data set comprises data from 12 European cohort studies. The
relationship between BMI and CVD mortality was examined in each BMI category
using univariable and multivariable (Cox) analyses. The SCORE population was also
divided into gender and age strata: under 40, 40-49, 50-59, and over 60. The rate
of CVD mortality in each BMI category was calculated within each gender and age
stratum. Relationships between BMI and other CVD risk factors were also examined.
RESULTS: There was a strong, graded but J-shaped univariable relationship between
BMI and CVD mortality in both genders. Each 5-unit increase in BMI was associated
with an increase in CVD mortality of 34% in men and 29% in women. The hazard
ratios remained significant when adjusted for age, self-reported smoking status,
total cholesterol, and systolic blood pressure (SBP). On additional adjustment
for diabetes and high-density lipoprotein cholesterol (HDL), the association
between BMI and CVD mortality did not persist. In all age groups except those
over 60 there were significant relationships between increased BMI and CVD
mortality. In the over-60 age group the only significant relationships with
mortality were in underweight and severely overweight women and mildly obese men.
After adjustment for age, each 1-unit increase in BMI was associated with a 1.14
mmHg increase in SBP, 0.055 mmol/l increase in total cholesterol, and a 0.024
mmol/l decrease in HDL in men. Figures were slightly lower in women. CONCLUSIONS:
Overall, overweight and obesity relate to CVD mortality in a strong and graded
manner. The effects are greater in women and markedly so in younger persons. It
is likely that a substantial part of the BMI-associated risk of CVD mortality is
mediated through other known CVD risk factors. This increases the public health
importance of BMI as both a simple indicator and mediator of CVD risk.

Langue : ANGLAIS

Tiré à part : OUI