Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1;46(8):1531-1540.
doi: 10.2337/dc23-0294.

Relationship Among Diabetes, Obesity, and Cardiovascular Disease Phenotypes: A UK Biobank Cohort Study

Oliver I Brown  1 , Michael Drozd  1 , Hugo McGowan  1 , Marilena Giannoudi  1 , Marcella Conning-Rowland  1 , John Gierula  1 , Sam Straw  1 , Stephen B Wheatcroft  1 , Katherine Bridge  1 , Lee D Roberts  1 , Eylem Levelt  1 , Ramzi Ajjan  1 , Kathryn J Griffin  1 , Marc A Bailey  1 , Mark T Kearney  1 , Richard M Cubbon  1
Affiliations

Relationship Among Diabetes, Obesity, and Cardiovascular Disease Phenotypes: A UK Biobank Cohort Study

Oliver I Brown et al. Diabetes Care. .

Abstract

Objective: Obesity and diabetes frequently coexist, yet their individual contributions to cardiovascular risk remain debated. We explored cardiovascular disease biomarkers, events, and mortality in the UK Biobank stratified by BMI and diabetes.

Research design and methods: A total of 451,355 participants were stratified by ethnicity-specific BMI categories (normal, overweight, obese) and diabetes status. We examined cardiovascular biomarkers including carotid intima-media thickness (CIMT), arterial stiffness, left ventricular ejection fraction (LVEF), and cardiac contractility index (CCI). Poisson regression models estimated adjusted incidence rate ratios (IRRs) for myocardial infarction, ischemic stroke, and cardiovascular death, with normal-weight nondiabetes as comparator.

Results: Five percent of participants had diabetes (10% normal weight, 34% overweight, and 55% obese vs. 34%, 43%, and 23%, respectively, without diabetes). In the nondiabetes group, overweight/obesity was associated with higher CIMT, arterial stiffness, and CCI and lower LVEF (P < 0.005); these relationships were diminished in the diabetes group. Within BMI classes, diabetes was associated with adverse cardiovascular biomarker phenotype (P < 0.005), particularly in the normal-weight group. After 5,323,190 person-years follow-up, incident myocardial infarction, ischemic stroke, and cardiovascular mortality rose across increasing BMI categories without diabetes (P < 0.005); this was comparable in the diabetes groups (P-interaction > 0.05). Normal-weight diabetes had comparable adjusted cardiovascular mortality to obese nondiabetes (IRR 1.22 [95% CI 0.96-1.56]; P = 0.1).

Conclusions: Obesity and diabetes are additively associated with adverse cardiovascular biomarkers and mortality risk. While adiposity metrics are more strongly correlated with cardiovascular biomarkers than diabetes-oriented metrics, both correlate weakly, suggesting that other factors underpin the high cardiovascular risk of normal-weight diabetes.

PubMed Disclaimer

Conflict of interest statement

Duality of Interest. S.S. has received speaker fees, honoraria, and nonfinancial support from AstraZeneca. R.A. has received institutional research grants from Abbott Diabetes Care, Bayer, Eli Lilly, Novo Nordisk, Roche, and Takeda and honoraria and consultant fees from Abbott Diabetes Care, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Menarini, Merck Sharp & Dohme, Novo Nordisk, and Takeda. M.A.B. has received speaker fees from Medicon and Amgen. M.T.K. has received honoraria from AstraZeneca, speaker fees from Merck and Novo Nordisk, and unrestricted research awards from AstraZeneca and Medtronic. No other potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
See this image and copyright information in PMC

References

    1. Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circ Res 2020;126:1477–1500 - PubMed
    1. Adams KF, Schatzkin A, Harris TB, et al. . Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763–778 - PubMed
    1. Wildman RP, Mackey RH, Bostom A, Thompson T, Sutton-Tyrrell K. Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension 2003;42:468–473 - PubMed
    1. Raghavan S, Vassy JL, Ho YL, et al. . Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. J Am Heart Assoc 2019;8:e011295. - PMC - PubMed
    1. Chen Y, Copeland WK, Vedanthan R, 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. BMJ 2013;347:f5446. - PMC - PubMed

Publication types