Abstract
BackgroundWe determined the proportion of the effects of body mass index (BMI) or its categories on cardiometabolic outcomes mediated through systolic blood pressure (SBP), total cholesterol and fasting glucose.MethodsCox regression analyses were performed for incident outcomes among Turkish Adult Risk Factor study participants in whom the three mediators had been determined (n = 2158, age 48.5 ± 11 years). Over a mean 10.2-years’ follow-up, new coronary heart disease (CHD) developed in 406, diabetes in 284 individuals, and 149 CHD deaths occurred.ResultsHazard ratios (HR) of BMI for incident diabetes were no more than marginally attenuated by the 3 mediators including glucose, irrespective of gender. Compared to “normal-weight”, sex- and age-adjusted RRs for incident CHD of overweight and obesity were 1.40 and 2.24 (95 % CI 1.68; 2.99), respectively, in gender combined. Only three-tenths of the excess risk was retained by BMI in men, six-tenths in women. No mediation of glycemia was discerned in males, in contrast to greatest mediation in females. HR of age-adjusted continuous BMI was a significant but modest contributor to CHD mortality in each gender. While the BMI risk of CHD death was abolished by mediation of SBP in men, HR strengthened to over two-fold in women through mediation of fasting glucose.ConclusionsMediation of adiposity by 3 traditional factors exhibited among Turkish adults strong gender dependence regarding its magnitude for CHD risk and the mediation by individual risk factors. Retention of the large part of risk for diabetes in each sex and for CHD in women likely reflects underlying autoimmune activation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0134-6) contains supplementary material, which is available to authorized users.
Highlights
We determined the proportion of the effects of body mass index (BMI) or its categories on cardiometabolic outcomes mediated through systolic blood pressure (SBP), total cholesterol and fasting glucose
Many studies have shown that cardiovascular risk of excess adiposity is mediated mainly by traditional risk factors such as systolic blood pressure (SBP), levels of total cholesterol and glucose, or diabetes [1,2,3,4]
The role of BMI in cardiovascular disease in the AsiaPacific region has been studied in a meta-analysis [5], and the association of overweight with increased coronary heart disease (CHD) risk independent of BP and cholesterol level has been investigated in another metaanalysis [6]
Summary
We determined the proportion of the effects of body mass index (BMI) or its categories on cardiometabolic outcomes mediated through systolic blood pressure (SBP), total cholesterol and fasting glucose. Many studies have shown that cardiovascular risk of excess adiposity is mediated mainly by traditional risk factors such as systolic blood pressure (SBP), levels of total cholesterol and glucose, or diabetes [1,2,3,4]. The most extensive quantification of the effects of high BMI, and of overweight and obesity on CHD mediated through SBP, serum cholesterol, and. Though nearly one half of excess risk for CHD due to high BMI was mediated through 3 metabolic risk factors, maintaining optimal body weight was needed for the full benefits
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