Body Mass Index From Early-, Mid-, and Older-Adulthood and Risk of Heart Failure and Atherosclerotic Cardiovascular Disease: MESA

Abstract

Background Obesity contributes significantly to risk of atherosclerotic cardiovascular disease (ASCVD) and especially for heart failure (HF). An elevated body mass index (BMI) in older adults might not carry the same risk as in younger adults, but measured weights at other lifetime points are often not available. We determined the associations of self-reported weights from early- and mid-adulthood, after accounting for measured weight at older age, with incident HF/ASCVD risk. Methods and Results We studied 6437 MESA (Multi-Ethnic Study of Atherosclerosis) participants (aged 45-84, free of baseline HF/ASCVD) with self-reported weights at ages 20 and 40 years (by questionnaire), measured weights at up to 5 in-person examinations (2000-2012), and follow-up for adjudicated HF/ASCVD events. Participant mean±SD age at the baseline examination was 62.2±10.2 years. Over median follow-up of 13 years, 290 HF and 828 ASCVD events occurred. After adjustment for cardiovascular risk factors and baseline BMI, higher self-reported weights at ages 20 and 40 years were independently associated with increased risk of incident HF with hazard ratios (95% confidence interval) of 1.27 (1.07-1.50) and 1.36 (1.18-1.57), respectively, per 5-kg/m² higher BMI. For incident ASCVD, only higher BMI at age 20 years was associated after accounting for current BMI (1.13 [1.01-1.26] per 5 kg/m²). Obesity during follow-up examinations was also associated with incident HF (1.72 [1.21-2.45]) but not ASCVD. Conclusions Self-reported lifetime weight is a low-tech tool easily utilized in any clinical encounter. Although subject to recall bias, self-reported weights may provide prognostic information about future HF risk, incremental to current BMI, in a multiethnic cohort of middle-aged to older adults. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT00005487.

Keywords: cardiovascular disease; heart failure; lifetime weights; obesity; prevention.

Figure 1

A tale of 2 patients: current office weight in older adulthood vs self‐reported weights in early‐ and mid‐adulthood. ASCVD indicates atherosclerotic cardiovascular disease risk; BMI, body mass index; Chol, cholesterol; HDL, high‐density lipoprotein cholesterol; SBP, systolic blood pressure; y.o., years old.

Figure 2

Participant BMI change through adulthood. BMI indicates body mass index.

Figure 3

Multivariable‐adjusted hazard ratios* for incident HF (A) and incident ASCVD (B) by BMI at each age point. *Using restricted cubic spline with knot at BMI of 25 kg/m² and adjusted for age at baseline, sex, race/ethnicity, center, education, smoking, physical activity, healthy diet score, total cholesterol, HDL cholesterol, use of cholesterol‐lowering medications, systolic blood pressure, use of antihypertensive medications, and diabetes mellitus. ASCVD indicates atherosclerotic cardiovascular disease risk; BMI, body mass index; CVD, cardiovascular disease; HDL, high‐density lipoprotein cholesterol; HF, heart failure; HR, hazard ratios.