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

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 Communiti...

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Published in:Journal of the American Heart Association Vol. 10; no. 24; p. e019946
Main Authors: Raffield, Laura M., Howard, Annie Green, Graff, Misa, Lin, Dan‐Yu, Cheng, Susan, Demerath, Ellen, Ndumele, Chiadi, Palta, Priya, Rebholz, Casey M., Seidelmann, Sara, Yu, Bing, Gordon‐Larsen, Penny, North, Kari E., Avery, Christy L.
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 21.12.2021
Wiley
Subjects:
Atherosclerosis - epidemiology
cardiovascular disease
Cardiovascular Diseases - epidemiology
Female
Heart Disease Risk Factors
Humans
latent class models
Male
Middle Aged
obesity
Obesity - epidemiology
Original Research
Patient Acuity
latent class models
cardiovascular disease
obesity
ISSN:2047-9980, 2047-9980
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Summary: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, <0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, <0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, =0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, =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, <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, =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.
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Supplemental Material for this article is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.121.019946
L. M. Raffield, A. G. Howard, P. Gordon‐Larsen, K. E. North, and C. L. Avery contributed equally.
For Sources of Funding and Disclosures, see page 12.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.121.019946