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Explanation for the CHD Risk in Individuals with High BMI

Dec 12, 2013
 

Three specific factors explained why these patients have a higher risk of CHD events….

For individuals with a high body mass index, over half of the increased risks for coronary heart disease can be explained by a combination of three factors — blood pressure, blood glucose and cholesterol. In addition, these three factors explained over 75% of increased risk of stroke in individuals with a high BMI. These results are due to an extensive systematic review of 97 international studies. Of these three factors, the most important was lowering blood pressure in decreasing the risk of stroke and CHD.

 

Evaluating over 1.8 million patients and following them for a median of 13 years, over 57,000 CHD events and 31,000 stroke events were recorded. For each 5 kg/m2 increase in BMI, the hazard ratio for CHD was 1.27 and for stroke it was 1.18. When adjusted for blood pressure, glucose and cholesterol, the hazard ratios were 1.15 for CHD and 1.04 for stroke. This suggests that over 45% of the excess risk for CHD and over 75% of the excess risk for stroke was due to these three risk factors.

For obese individuals (BMI >30 kg/m2) these three risk factors accounted for 44% of excess risk of CHD and 69% of excess risk of stroke compared to those that are normal weight (BMI >20 to <25 kg/m2). For overweight individuals (BMI >25 to <30 kg/m2) these three risk factors accounted for 50% of excess risk of CHD and 98% of excess risk for stroke.

The solution, according to the authors, is to address obesity early, even in those who are only borderline or moderately obese. Treating blood pressure, glucose and cholesterol in these individuals can markedly decrease their risk for future cardiovascular events. Therefore the authors recommend aggressively treating blood pressure, lipid level and glucose abnormalities while also calling for weight loss and increased fitness.

Practice Pearls:
  • Blood pressure, glucose and cholesterol are responsible for a 44% excess risk of CHD and 69% excess risk of stroke in obese individuals (BMI >30 kg/m2).
  • The same three factors are responsible for a 50% excess risk of CHD and 98% excess risk of stroke in overweight individuals (BMI >25 to <30 kg/m2).
  • Blood pressure alone accounts for 31% of excess risk for CHD and 65% excess risk for stroke among both overweight and obese individuals.

The Lancet, November 2013