Long- and short-term weight change and incident coronary heart disease and ischemic stroke: the Atherosclerosis Risk in Communities Study

Abstract

Weight gain increases the prevalence of obesity, a risk factor for cardiovascular disease. Nevertheless, unintentional weight loss can be a harbinger of health problems. The Atherosclerosis Risk in Communities Study (1987-2009) included 15,792 US adults aged 45-64 years at baseline and was used to compare associations of long-term (30 years) and short-term (3 years) weight change with the risks of coronary heart disease (CHD) and ischemic stroke. Age-, gender-, and race-standardized incidence rates were 4.9 (95% confidence interval (CI): 4.6, 5.2) per 1,000 person-years for CHD and 2.5 (95% CI: 2.3, 2.8) per 1,000 person-years for stroke. After controlling for baseline body mass index and other covariates, long-term weight gain (since age 25 years) of more than 2.7% was associated with elevated CHD risk, and any long-term weight gain was associated with increased stroke risk. Among middle-aged adults, short-term (3-year) weight loss of more than 3% was associated with elevated immediate CHD risk (hazard ratio = 1.46, 95% CI: 1.18, 1.81) and stroke risk (hazard ratio = 1.45, 95% CI: 1.10, 1.92). Risk tended to be larger in adults whose weight loss did not occur through dieting. Avoidance of weight gain between early and middle adulthood can reduce risks of CHD and stroke, but short-term, unintentional weight loss in middle adulthood may be an indicator of immediate elevated risk that has not previously been well recognized.

Keywords: body mass index; body weight changes; coronary heart disease; ischemic stroke.

Figure 1.

Study designs used for analysis of the associations between long-term weight change (A) and short-term weight change (B) and incident coronary heart disease and ischemic stroke in the Atherosclerosis Risk in Communities Study, 1987–2009.

Figure 2.

Hazard ratios for incident coronary heart disease according to long- and short-term weight change in the Atherosclerosis Risk in Communities Study, 1987–2009. Long-term weight change was analyzed using 3-knot spline models with adjustment for smoking status at age 25 years and for race/field center, age, gender, education, smoking status, alcohol consumption, physical activity, and height at examination 1, as well as with and without adjustment for body mass index (BMI; weight (kg)/height (m)²) at age 25 years. Short-term weight change was analyzed using linear models with adjustment for race/field center, age, gender, education, and height at examination 1 and for time-dependent alcohol consumption, physical activity, and smoking status, as well as with and without adjustment for BMI at the beginning of the weight-change interval.

Figure 3.

Hazard ratios for incident ischemic stroke according to long- and short-term weight change in the Atherosclerosis Risk in Communities Study, 1987–2009. Long-term weight change was analyzed using linear models with adjustment for smoking status at age 25 years and for race/field center, age, gender, education, smoking status, alcohol consumption, physical activity, and height at examination 1, as well as with and without adjustment for body mass index (BMI; weight (kg)/height (m)²) at age 25 years. Short-term weight change was analyzed using linear models with adjustment for race/field center, age, gender, education, and height at examination 1 and for time-dependent alcohol consumption, physical activity, and smoking status, as well as with and without adjustment for BMI at the beginning of the weight-change interval.