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Abstract
BackgroundAlthough 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.MethodsThis 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.Results264,230 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.ConclusionThe 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.
Highlights
Obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of longterm body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified
Similar to group based trajectory modelling (GBTM) methods employed in a previous study [28], we identified the ideal number of trajectory groups for our study population, by estimating the Bayesian information criterion (BIC) in 2- group models, 3-group models and 4-group models
Study population A total of 264,230 overweight and obese individuals were included in the study
Summary
Obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of longterm body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified. Obesity and overweight increase the risk of cardiovascular disease [1] and heart failure [2], and are important causes of morbidity and mortality globally. Long-term weight loss in obese individuals through selfguided efforts or behavioural interventions is not always sustained. While weight loss interventions may improve cardiovascular risk factors [9], metabolic function [10] or even reverse type 2 diabetes [11], it is unclear what the long term effect of weight changes are on cardiovascular endpoints
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