TY - JOUR
T1 - Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants
AU - Cruijsen, Esther
AU - Bonekamp, Nadia E.
AU - Koopal, Charlotte
AU - Winkels, Renate M.
AU - Visseren, Frank L.J.
AU - Geleijnse, J.M.
A2 - van Damme, I.
A2 - Heerkens, L.
A2 - Khandpur, N.
A2 - Jacobo Cejudo, M.G.
A2 - Pertiwi, K.
A2 - van Westing, A.C.
A2 - Cramer, M.J.
A2 - Nathoe, H.M.
A2 - van de Meer, M.G.
A2 - de Borst, G.J.
A2 - Teraa, M.
A2 - Bots, M.L.
A2 - van Smeden, M.
A2 - Emmelot-Vonk, M.H.
A2 - de Jong, P.A.
A2 - Lely, A.T.
A2 - van der Kaaij, N.P.
A2 - Kappelle, L.J.
A2 - Ruigrok, Y.M.
A2 - Verhaar, M.C.
A2 - Dorresteijn, J.A.N.
A2 - Visseren, F.L.J.
PY - 2024/5
Y1 - 2024/5
N2 - Background and aims Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants. Methods 10,370 CAD patients (mean age *65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort–Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health). Results During *10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI *27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25–30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95% CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level. Conclusions CAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.
AB - Background and aims Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants. Methods 10,370 CAD patients (mean age *65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort–Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health). Results During *10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI *27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25–30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95% CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level. Conclusions CAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.
U2 - 10.1371/journal.pone.0303329
DO - 10.1371/journal.pone.0303329
M3 - Article
C2 - 38820357
AN - SCOPUS:85195014149
SN - 1932-6203
VL - 19
JO - PLoS ONE
JF - PLoS ONE
IS - 5
M1 - e0303329
ER -
