We estimated the average numbers of years lived with and without cardiovascular disease (CVD) in normal weight, overweight, and obese individuals, aged ≥30 years.
A total of 7529 participants were recruited. The multi-state Markov model was used to obtain hazard ratios (HRs) for three transitions (CVD free to nonfatal CVD, CVD free to all-cause death, and nonfatal CVD to all-cause death) stratified by body mass index (BMI) categories at baseline and adjusted for confounders including sex, age, smoking, family history of premature CVD, education and physical activity. Life expectancies (LEs) were also estimated for each transition stratifying by BMI categories and sex.
We found 986 incident cases of nonfatal CVD and 669 overall deaths (236 CVD deaths) after more than 18 years of follow-up. Overweight and obesity were associated with an increased risk of nonfatal CVD (HR, 1.42 (95% confidence interval (CI) 1.21–1.66) and (1.64, 1.37–1.96), respectively), compared with normal weight individuals. Overweight and obesity were also associated with lower risk of mortality without CVD (0.39, 0.20–0.77) and (0.35, 0.14–0.85), respectively. Among those with CVD, overweight compared with normal weight was associated with a lower risk of mortality (0.72, 0.56–0.94). Total LEs for both men and women with overweight and obesity were not significantly different from their normal weight counterparts. Compared with normal weight individuals, men and women with obesity lived 4.1 (CI: −6.3, −1.3) and 4.3 (−6.4, −2.0) fewer years free of CVD; however, they lived 3.9 (2.1, 6.0) and 3.7 (2.1, 5.6) longer years with CVD than their normal weight counterparts, respectively.
We demonstrated that although total LE was not influenced by higher BMI; individuals with overweight and obesity could expect longer longevity after diagnosis of nonfatal CVD. These extra years of life impose financial burden on both patients and the health care system.
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Stenholm S, Head J, Aalto V, Kivimäki M, Kawachi I, Zins M, et al. Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Obes. 2017;41:769.
World Health Organization. Obesity and overweight. Geneva: World Health Organization; 2018 http://www.who.int/mediacentre/factsheets/fs311/en/.
Kilpi F, Webber L, Musaigner A, Aitsi-Selmi A, Marsh T, Rtveladze K, et al. Alarming predictions for obesity and non-communicable diseases in the Middle East. Public Health Nutr. 2014;17:1078–86.
Esteghamati A, Khalilzadeh O, Mohammad K, Meysamie A, Rashidi A, Kamgar M, et al. Secular trends of obesity in Iran between 1999 and 2007: National Surveys of Risk Factors of Non-communicable Diseases. Metabol Syndr Relat Disord. 2010;8:209–13.
Afarideh M, Ghajar A, Nikdad MS, Alibakhshi A. Sex-specific aspects of bariatric surgery in iran are far from understood. J Am Coll Surg. 2016;223:420–1.
Hosseinpanah F, Mirbolouk M, Mossadeghkhah A, Barzin M, Serahati S, Delshad H, et al. Incidence and potential risk factors of obesity among Tehranian adults. Prevent Med. 2016;82:99–104.
Ahmad MH, Nishi N, Yusoff M, Fadhli M, Aris T. Cardiovascular disease risk and its association with body mass index in malaysians based on the world health organization/international society of hypertension risk prediction chart. Health Sci J. 2018;12:550.
Ghorpade AG, Shrivastava SR, Kar SS, Sarkar S, Majgi SM, Roy G. Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India. Int J Health Policy Manag. 2015;4:531.
Chen Y, Copeland WK, Vedanthan R, Grant E, Lee JE, Gu D, et al. Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium. Br Med J. 2013;347:f5446.
Kabootari M, Asgari S, Mansournia MA, Khalili D, Valizadeh M, Azizi F, et al. Different weight histories and risk of incident coronary heart disease and stroke: tehran lipid and glucose study. J Am Heart Assoc. 2018;7:e006924.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.
Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, et al. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol. 2018;15:106–19.
Sardarinia M, Akbarpour S, Lotfaliany M, Bagherzadeh-Khiabani F, Bozorgmanesh M, Sheikholeslami F, et al. Risk factors for incidence of cardiovascular diseases and all-cause mortality in a middle eastern population over a decade follow-up: tehran lipid and glucose study. PLoS ONE. 2016;11:e0167623.
Nalini M, Oranuba E, Poustchi H, Sepanlou SG, Pourshams A, Khoshnia M, et al. Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran. BMJ Open. 2018;8:e021479.
Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71–82.
Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138:24–32.
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289:187–93.
Silva M, Laet C, Nusselder WJ, Mamun AA, Peeters A. Adult obesity and number of years lived with and without cardiovascular disease. Obesity. 2006;14:1264–73.
Grover SA, Kaouache M, Rempel P, Joseph L, Dawes M, Lau DC, et al. Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study. Lancet Diabetes Endocrinol. 2015;3:114–22.
Dhana K, Berghout M, Peeters A, Ikram M, Tiemeier H, Hofman A, et al. Obesity in older adults and life expectancy with and without cardiovascular disease. Int J Obesity. 2016;40:1535.
Nusselder WJ, Franco OH, Peeters A, Mackenbach JP. Living healthier for longer: comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease. BMC Public Health. 2009;9:487.
O’Doherty MG, Cairns K, O’Neill V, Lamrock F, Jorgensen T, Brenner H, et al. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol. 2016;31:455–68.
Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA cardiology. 2018;3:280–7.
Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9:13–27.
Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: tehran Lipid and Glucose Study phase II. Trials. 2009;10:5.
Khalili D, Azizi F, Asgari S, Zadeh-Vakili A, Momenan AA, Ghanbarian A. et al. Outcomes of a longitudinal population-based Cohort Study and pragmatic community trial: findings from 20 years of the Tehran Lipid and Glucose Study. Int J Endocrinol Metabol. 2018;16(4 Suppl):e84748, https://doi.org/10.5812/ijem.84748. eCollection 2018 Oct.
Mirmiran Mohammadi, Allahverdian Azizi. Estimation of energy requirements for adults: Tehran lipid and glucose study. Int J Vitamin Nutr Res. 2003;73:193–200.
Jeon CY, Lokken RP, Hu FB, Van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care. 2007;30:744–52.
Cox DR. The theory of stochastic processes: Routledge. United States: Chapman & Hall/CRC; 2017.
Andersen PK, Keiding N. Multistate models for event history analysis. Stat Methods Med Res. 2002;11:91–115.
Jackson C. Multistate models for panel data: the msm package for R. J Stat Softw. 2011;38:1–29.
World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 2000.
Van Den Hout A, Jagger C, Matthews FE. Estimating life expectancy in health and ill health by using a hidden Markov model. J Royal Stat Soci: Series C (Applied Statistics). 2009;58:449–65.
Buuren SV. Groothuis-oudshoorn K mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–68.
Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867–72.
Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al. Obesity and the risk of heart failure. New Engl J Med. 2002;347:305–13.
Boloukat RR, Ramezankhani A, Hasheminia M, Tasdighi E, Azizi F, Hadaegh F. Impact of blood pressure, cholesterol and glucose in the association between adiposity measures and coronary heart disease and stroke among Iranian population. Clin Nutr. 2018;37:2060–67.
Ndumele CE, Matsushita K, Lazo M, Bello N, Blumenthal RS, Gerstenblith G, et al. Obesity and subtypes of incident cardiovascular disease. J Am Heart Assoc. 2016;5. pii: e003921. https://doi.org/10.1161/JAHA.116.003921.
Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1530–8.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Eng J Med. 1999;341:1097–105.
Grabowski DC, Ellis JE. High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc. 2001;49:968–79.
Dong SY, Wang ML, Li ZB, Dong Z, Liu YQ, Lu RJ, et al. Obesity, weight change, and mortality in older adults with metabolic abnormalities. Nutr Metabol Cardiovas Dis. 2018;28:749–55.
He X, Liu C, Chen Y, He J, Dong Y. Overweight without central obesity, cardiovascular risk, and all-cause mortality. Mayo Clin Proc. 2018;93:709–20.
Pandya A, Gaziano TA, Weinstein MC, Cutler D. More americans living longer with cardiovascular disease will increase costs while lowering quality of life. Health Aff. 2013;32:1706–14.
Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality. New Engl J Med. 1998;338:1–7.
Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368:666–78.
Rabani S, Sardarinia M, Akbarpour S, Azizi F, Khalili D, Hadaegh F. 12-year trends in cardiovascular risk factors (2002–2005 through 2011–2014) in patients with cardiovascular diseases: tehran lipid and glucose study. PLoS ONE. 2018;13:e0195543.
Auyeung TW, Lee JS, Leung J, Kwok T, Leung PC, Woo J. Survival in older men may benefit from being slightly overweight and centrally obese–a 5-year follow-up study in 4000 older adults using DXA. The J Gerontol Ser A Biol Sci Med Sci. 2010;65:99–104.
We express our appreciation to the participants from district No13 of Tehran, for their enthusiastic support in this study. The authors wish to acknowledge Ms Niloofar Shiva for critical editing of English grammar and syntax of the manuscript.
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Fekri, N., Khaloo, P., Ramezankhani, A. et al. Association of body mass index with life expectancy with and without cardiovascular disease. Int J Obes (2019) doi:10.1038/s41366-019-0464-3