Reducing the Population Burden of Coronary Heart Disease by Modifying Adiposity: Estimates From the ARIC Study

Kapuaola S. Gellert, Alexander P. Keil, Donglin Zeng, Catherine R. Lesko, Ronald E. Aubert, Christy L. Avery, Pamela L. Lutsey, Anna Maria Siega-Riz, B. Gwen Windham, Gerardo Heiss

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Excess adiposity, which affects 69% of US adults, increases coronary heart disease (CHD) risk in an association that manifests below conventional obesity cut points. The population-level impact on CHD risk that is attainable through modest adiposity reductions in populations is not well characterized. We estimated the effect of hypothetical reductions in both body mass index (BMI) and waist circumference (WC) on CHD incidence. Methods and Results: The study population included 13 610 ARIC (Atherosclerosis Risk in Communities) participants. Our hypothetical reduction in BMI or WC was applied relative to the temporal trend, with no hypothetical reduction among those with BMI >24 or WC >88 cm, respectively. This threshold for hypothetical reduction is near the clinical guidelines for excess adiposity. CHD risk differences compared the hypothetical reduction with no reduction. Sensitivity analysis was conducted to estimate the effect of applying the hypothetical BMI reduction at the established overweight cut point of 25. Cumulative 12-year CHD incidence with no intervention was 6.3% (95% CI, 5.9–6.8%). Risk differences following the hypothetical BMI and WC reductions were −0.6% (95% CI, −1.0% to −0.1%) and −1.0% (95% CI, −1.4% to −0.5%), respectively. These results were robust for the sensitivity analyses. Consequently, we estimated that this hypothetical reduction of 5% in BMI and WC, respectively, could have prevented 9% and 16%, respectively, of the CHD events occurring in this study population over 12 years, after adjustment for established CHD risk factors. Conclusions: Meaningful CHD risk reductions could derive from modest reductions in adiposity attainable through lifestyle modification.

Original languageEnglish (US)
Article numbere012214
JournalJournal of the American Heart Association
Volume9
Issue number4
DOIs
StatePublished - Feb 18 2020

Bibliographical note

Funding Information:
The ARIC (Atherosclerosis Risk in Communities) study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Gellert was supported by the Ruth L. Kirschstein National Research Service Award for Individual Predoctoral Fellows (1F31HL120595-01). Availability of data and detailed policies for accessing ARIC (Atherosclerosis Risk in Communities) study data can be found online. The ARIC study data are made available through the National Heart, Lung, and Blood Institute BioLINCC repository. This study was conducted in the community-based, prospective, and predominantly black and white ARIC study cohort, which includes 15?792 adults aged 45 to 64?years. ARIC cohort participants were recruited using probability sampling from 4 US communities: Forsyth County, North Carolina; Jackson, Mississippi; northwest suburbs of Minneapolis, Minnesota; and Washington County, Maryland.

Keywords

  • body mass index
  • cardiovascular disease prevention
  • cardiovascular events
  • coronary heart disease
  • coronary heart disease risk

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