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. 2021 Apr 15;21(1):576.
doi: 10.1186/s12889-021-10606-1.

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

Barbara Iyen  1 , Stephen Weng  2 , Yana Vinogradova  2 , Ralph K Akyea  2 , Nadeem Qureshi  2 , Joe Kai  2
Affiliations

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

Barbara Iyen et al. BMC Public Health. .

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 33.8 kg/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 1.06 kg/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.

Keywords: BMI trajectory; Body mass index (BMI); Cardiovascular disease; Heart failure; Obesity; Overweight.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing how the study population of overweight and obese subjects were derived
Fig. 2
Fig. 2
Body mass index (BMI) trajectories using BMI measures at baseline and then follow-up at 2 years, 5 years, 8 years and 10 years. Percentages below plot represent percentage of study population within each trajectory group. Mean BMI change in trajectory group 1 (overweight-stable group): + 0.99 (SD 3.10) kg/m2 . Mean BMI change in trajectory group 2 (obese class 1-stable group): + 1.19 (SD 1.67) kg/m2. Mean BMI change in trajectory group 3 (obese class 2-stable group): + 1.04 (SD 4.59) kg/m2 Mean BMI change in trajectory group 4 (obese class 3-stable group): + 0.62 (SD 6.27) kg/m2
Fig. 3
Fig. 3
Kaplan Meier survival plots showing cumulative outcome-free survival of individuals in the 4 BMI trajectory groups. With increasing BMI trajectory groups, individuals had higher risks of non-fatal cardiovascular outcomes, heart failure and mortality
See this image and copyright information in PMC

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