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Epidemiology and Population Health

Overweight or obesity increases the risk of cardiovascular disease among older Australian adults, even in the absence of cardiometabolic risk factors: a Bayesian survival analysis from the Hunter Community Study

Abstract

Objective

To estimate the risk of cardiovascular disease (CVD) in older adults with overweight or obesity without metabolic risk factors using a Bayesian survival analysis.

Design

Prospective cohort study with median follow-up of 9.7 years.

Setting

Newcastle, New South Wales, Australia.

Participants

A total of 2313 community-dwelling older men and women.

Intervention/exposure

Participants without known CVD and with a body mass index (BMI) ≥ 18.5 kg m2 were stratified by BMI and metabolic risk to create six BMI-metabolic health categories. Metabolic risk was defined according to the International Diabetes Federation criteria for metabolic syndrome. ‘Metabolically healthy’ was defined as absence of metabolic risk factors. Bayesian survival analysis, incorporating prior information from a previously published meta-analysis was used to assess the effect of BMI-metabolic health categories on time from recruitment to CVD.

Main outcome

Incident physician-diagnosed CVD, defined as fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, angina, or coronary revascularisation procedure, was determined by linkage to hospital admissions records and Medicare Australia data. Secondary outcomes were cardiovascular mortality and all-cause mortality.

Results

From 2313 adults with complete metabolic health data over a median follow-up of 9.7 years, 283 incident CVD events, 58 CVD related deaths and 277 deaths from any cause occurred. In an adjusted Bayesian survival model of complete cases with informative prior and metabolically healthy normal weight as the reference group, the risk of CVD was increased in metabolically healthy overweight (HR = 1.52, 95% credible interval 0.96–2.36), and in metabolically healthy obesity (HR = 1.86, 95% credible interval 1.14–3.08). Imputation of missing metabolic health and confounding data did not change the results.

Conclusion

There was increased risk of CVD in older adults with overweight or obesity, even in the absence of any metabolic abnormality. This argues against the notion of ‘metabolically healthy’ overweight or obesity.

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Fig. 1: Flow diagram for selection of participants from the Hunter Community Study (HCS) for the study of the association between obesity-metabolic health phenotypes and risk of cardiovascular diseaese.
Fig. 2: Kaplan–Meier Survival Curves showing variation in survival probability for the six obesity-metabolic health phenotypes over time.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was a collaboration between the Hunter Community Study and the Australian Rural Mental Health Study, named xTEND. The xTEND project was funded by the Hunter Medical Research Institute and Beyondblue, the national depression initiative. The Hunter Community Study has been funded by the University of Newcastle Strategic Initiative Fund, the Vincent Family Foundation, and the Brawn Fellowship. The Australian Rural Mental Health Study was funded by the National Health and Medical Research Council (NHMRC, Project Grants #401241 and #631061) and also supported by a Research Infrastructure Capacity Building Grant from NSW Department of Health to the Australian Rural Health Research Collaboration.

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Contributions

MM was the study lead investigator. MM, KW, JO planned the study. MM, KW supervised progress of the study. JO reviewed literature and contributed to data analysis. MM, JO wrote the paper. JA was lead investigator for the Hunter Community Study. SH prepared data for analysis. SO performed data analysis. MM, JO wrote the paper. All authors reviewed the paper from draft to completion.

Corresponding author

Correspondence to Mark McEvoy.

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Opio, J., Wynne, K., Attia, J. et al. Overweight or obesity increases the risk of cardiovascular disease among older Australian adults, even in the absence of cardiometabolic risk factors: a Bayesian survival analysis from the Hunter Community Study. Int J Obes 47, 117–125 (2023). https://doi.org/10.1038/s41366-022-01241-w

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