Abstract
OBJECTIVE: The aim with the present study was to evaluate the association between pubertal body mass index (BMI) change and adult coronary artery calcification (CAC) score and risk of acute coronary events. APPROACH AND RESULTS: We included 37 672 men from the BMI Epidemiology Study and calculated their pubertal BMI change (BMI at 20 years−BMI at 8 years). Coronary artery computed tomography analysis of CAC score, midlife BMI, and major risk factors for coronary heart disease were available for a sub-cohort through linkage with the SCAPIS (Swedish Cardio Pulmonary Bioimage Study) cohort (n=922). Information on first acute coronary events was retrieved from Swedish national registers (n=37 672, events n=1873). Pubertal BMI change (odds ratio per SD increase, 1.32 [1.14–1.52]), but not childhood BMI, was associated with middle age CAC score ≥1. This association for pubertal BMI change was maintained after adjustment for midlife BMI at CAC analysis and in a model including major cardiovascular risk factors. Individuals who became overweight during puberty (hazard ratio, 2.11 [1.79–2.49]), but not those overweight at 8 years who normalized their weight during puberty, had substantially increased risk of acute coronary events compared with men who were never overweight. Among subjects with an acute coronary event, individuals with pubertal onset overweight were at increased risk of death due to the event. CONCLUSIONS: Pubertal BMI change is an independent predictor of CAC score and risk of acute coronary events in adult men. Excessive BMI increase during puberty may initiate the coronary atherosclerotic process, thereby increasing the risk and severity of adult acute coronary events.
Highlights
Two recent publications using the Mendelian randomization approach in the large UK Biobank cohort confirm the association between self-reported size in childhood and adult Coronary heart disease (CHD),[7] and body mass index (BMI) during childhood and adult asthma,[8] but further demonstrate that the associations are mainly mediated through high BMI in midlife.[7,8]
A high BMI in late adolescence has been reported to associate with increased risk of CHD.[9,10,11]
Through linkage with the SCAPIS study, to form the BEST-SCAPIS sub-cohort, we retrieved data on midlife CAC score, midlife BMI, and major risk factors for CHD measured at the time of CAC score measurement
Summary
The data that support the findings of this study are available from the corresponding author upon reasonable request and upon approval from the University of Gothenburg according to mandatory national law but are not publicly available due to privacy and ethical restrictions. The BMI Epidemiology Study Gothenburg The population-based BEST Gothenburg cohort was initiated with the overall aim to study the impact of BMI during childhood and puberty on adult diseases as previously described.[12,13,14] We collected data on height and weight during development from school health care records and at young adult age from military conscription tests (see Appendix and Table I in the Data Supplement). Because almost exclusively men underwent conscription, pubertal BMI change could only be estimated in males. The ethics committee of the University of Gothenburg, Sweden approved the BEST Gothenburg study. Expanded Methods Expanded Results Online Tables I. VI Online Figures I–IV Online Legends to Figure Online Figures SI–SII References 25–28
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