Abstract
Introduction: Individuals with an elevated body mass index (BMI) are at higher atherosclerotic cardiovascular diseases (ASCVD) risk. While the impact of an elevated BMI on ASCVD risk in individuals who are “metabolically healthy” is still debated, the respective contributions of BMI and actionable lifestyle and cardiometabolic risk factors on ASCVD risk remains largely unknown. We investigated the respective contributions of lifestyle and cardiometabolic risk factors and BMI to ASCVD incidence in apparently healthy individuals. Methods: We developed a cardiovascular health score (CVHS) based on three lifestyle (smoking status, fruits and vegetables consumption and physical activity levels) and six cardiometabolic (blood pressure, HbA1c, LDL-C, HDL-C, C-Reactive Protein and triglyceride levels) parameters. The study sample included 321,259 participants of the UK Biobank, free of ASCVD recruited between 2006 and 2010. As of August 2021, 15,699 of them had incident ASCVD (fatal or nonfatal myocardial infarction, ischemic stroke or cardiac revascularization procedures. The impact of the CVHS on incident ASCVD alone and in BMI categories was assessed using Cox proportional hazards adjusted for age, sex, ethnicity and deprivation. Results: Compared to participants with a very high CVHS (CVHS=9), those with a very low CVHS (CVHS=0) had a higher ASCVD risk (hazard ratio = 12.2 (95% CI, 6.7-22.2, p<0.001). Figure 1 presents the association between the CVHS and hazard ratio for incident ASCVD in four BMI categories. Conclusions: In participants of the UK Biobank, a cardiovascular health score based on lifestyle and cardiometabolic risk factors was strongly associated with incident ASCVD in all BMI categories. The relationship between BMI and ASCVD incidence across CVHS categories was inconsistent. Strategies aimed at improving healthy lifestyle habits and cardiometabolic risk factors may decrease ASCVD risk in everyone, regardless of their body weight.
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