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Epidemiology and Population Health

Association of obesity with cardiovascular disease in the absence of traditional risk factors



The association between obesity and cardiovascular disease (CVD) in people without traditional CVD risk factors is unclear. This study aimed to investigate the association of obesity with CVD and its subtypes in people without traditional CVD risk factors.


Based on the Kailuan cohort study, the included participants were divided into different groups according to levels of body mass index (BMI) and waist height ratio (WHtR), respectively. Multivariate Cox proportional hazard models were used to evaluate the associations.


This study included 31,955 participants [men 63.99%; mean age (48.14 ± 3.33) years]. During a median follow-up period of 12.97 (interquartile range: 12.68–13.17) years, 1298 cases of CVD were observed. Compared with the normal BMI group, the hazard ratios (HRs) for CVD, stroke, and myocardial infarction (MI) in the BMI obese group were 1.31 (95% confidence interval [CI] 1.11–1.55), 1.21 (95%CI 1.01–1.46), 1.62 (95%CI 1.13–2.33), respectively. Compared with the WHtR non-obese group, the HRs for CVD, stroke, and MI in the obese group were 1.25(95%CI 1.11–1.41), 1.18 (95%CI 1.03–1.34), 1.57 (95%CI 1.18–2.09), respectively. There was an interaction between age and WHtR (P for interaction was 0.043). The association between WHtR and CVD was stronger in people under 60 years old, with a HR of 1.44 (95%CI 1.24–1.67).


We found that obesity increased the risk of CVD in people without traditional CVD risk factors. The association of WHtR with CVD was stronger in people under 60 years old.

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Fig. 1: The flowchart of the study.
Fig. 2: Adjusted cubic spline for the hazard of incident cardiovascular disease by BMI and WHtR.

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Data availability

Some or all datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.


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We thank all study participants, their relatives, the members of the survey teams at the 11 regional hospitals of the Kailuan Medical Group; and the project development and management teams at the Beijing Tiantan Hospital and the Kailuan Group. This work was supported by National Key Research and Development Program of China (2022YFC3600600), Fund for Young Talents of Beijing Medical Management Center (QML20230505), National Natural Science Foundation of China (81773512), and Beijing Municipal Administration of Hospitals Incubating Program (PX2020021).

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HL, and YesongLiu drafted the manuscript and conducted the statistical analysis. XT revised the manuscript for intellectual content and interpreted the data. YZ, LL, ZZ, and LL interpreted the data. YZ and XJ collected the epidemiological and clinical data. YLiu, YLuo, and AW designed the study, had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version.

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Correspondence to Yeqiang Liu, Yanxia Luo or Anxin Wang.

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Luo, H., Liu, Y., Tian, X. et al. Association of obesity with cardiovascular disease in the absence of traditional risk factors. Int J Obes 48, 263–270 (2024).

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