Obesity Duration, Severity, and Distribution Trajectories and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities Study

Download as .RIS

Citation

Raffield, Laura M.; Howard, Annie Green; Graff, Mariaelisa; Lin, Dan-Yu; Cheng, Susan; Demerath, Ellen W.; Ndumele, Chiadi E.; Palta, Priya; Rebholz, Casey M.; & Seidelmann, Sara, et al. (2021). Obesity Duration, Severity, and Distribution Trajectories and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities Study. Journal of the American Heart Association, 10(24), e019946. PMCID: PMC9075238

Abstract

BACKGROUND RESEARCH: Examining the role of obesity in cardiovascular disease (CVD) often fails to adequately consider heterogeneity in obesity severity, distribution, and duration.
METHODS AND RESULTS: We here use multivariate latent class mixed models in the biracial Atherosclerosis Risk in Communities study (N=14 514; mean age=54 years; 55% female) to associate obesity subclasses (derived from body mass index, waist circumference, self-reported weight at age 25, tricep skinfold, and calf circumference across up to four triennial visits) with total mortality, incident CVD, and CVD risk factors. We identified four obesity subclasses, summarized by their body mass index and waist circumference slope as decline (4.1%), stable/slow decline (67.8%), moderate increase (24.6%), and rapid increase (3.6%) subclasses. Compared with participants in the stable/slow decline subclass, the decline subclass was associated with elevated mortality (hazard ratio [HR] 1.45, 95% CI 1.31, 1.60, P<0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, P<0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, P=0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, P=0.0008), adjusting for baseline body mass index and CVD risk factor profile. The moderate increase latent class was not associated with any significant differences in CVD risk as compared to the stable/slow decline latent class and was associated with a lower overall risk of mortality (HR 0.85, 95% CI 0.80, 0.90, P<0.0001), despite higher body mass index at baseline. The rapid increase latent class was associated with a higher risk of heart failure versus the stable/slow decline latent class (HR 1.34, 95% CI 1.10, 1.62, P=0.004).
CONCLUSIONS: Consideration of heterogeneity and longitudinal changes in obesity measures is needed in clinical care for a more precision-oriented view of CVD risk.

URL

http://dx.doi.org/10.1161/jaha.121.019946

Reference Type

Journal Article

Year Published

2021

Journal Title

Journal of the American Heart Association

Author(s)

Raffield, Laura M.
Howard, Annie Green
Graff, Mariaelisa
Lin, Dan-Yu
Cheng, Susan
Demerath, Ellen W.
Ndumele, Chiadi E.
Palta, Priya
Rebholz, Casey M.
Seidelmann, Sara
Yu, Bing
Gordon-Larsen, Penny
North, Kari E.
Avery, Christy L.

Article Type

Regular

PMCID

PMC9075238

Data Set/Study

Atherosclerosis Risk in Communities (ARIC) Study

Continent/Country

United States of America

State

Nonspecific

Race/Ethnicity

Black
White

ORCiD

Howard, AG - 0000-0003-0837-8166
Gordon-Larsen - 0000-0001-5322-4188
Avery - 0000-0002-1044-8162