Adiposity trajectories and cardiovascular disease risk in women: a population-based cohort study with a focus on menopausal status

Abstract

Objectives: A single measurement of adiposity indices could predict the incidence of cardiovascular disease (CVD); nonetheless their long-term pattern and its association with incident CVD are rarely studied. This study aimed to determine distinct trajectories of adiposity indices among participants of Tehran Lipid and Glucose Study (TLGS) and their association with incident CVD. Furthermore, this study aimed to investigate whether this association differed among individuals according to their menopausal status.

Method: A total of 6840 women participated in TLGS, aged 20 years and older were included in this study; they were followed for a median of 16 years. Body mass index (BMI), waist circumference (WC), conicity index (CI) and body roundness index (BRI) were included in the analysis as adiposity indices. The cohort outcome panel of medical specialists identified the CVD outcomes. Trajectory analyses were used to identify homogeneous distinct clusters of adiposity indices trajectories. The association between the trajectory group membership and incident CVD were explored by Cox proportional hazard models, with unadjusted and adjusted model for baseline age, physical activity, smoking status, menopause and family history of CVD.

Results: Three BMI trajectory groups of low, medium, and high and two trajectories for WC, BRI and CI were identified. Adjusted cox proportional hazard models revealed significant associations between the hazard of CVD experience and the high trajectory group of the BMI (HR: 2.06, 95% CI: 1.38-3.07), WC (HR: 2.71, 95% CI: 1.98-3.70), CI (HR: 1.87, 95% CI: 1.26-2.77) and BRI (HR: 1.55-95% CI: 1.12-2.15), compared to the low trajectory group. Subgroup analysis based on the menopausal status of participants showed that the HR of CVD incidences for all of trajectories adiposity indices, except BMI, was statistically significant. Adjusted cox proportional hazard models, in those women not reached menopause during study, revealed that the HR (95% CI) of CVD incidences for high trajectory of BMI, WC, CI and BRI were 2.80 (1.86-7.05); 2.09 (1.40-6.16); 1.72 (1.42-5.61), and 3.09 (1.06-9.01), respectively. These values for those were menopause at the initiation of the study were 1.40 (1.11, 2.53); 1.65 (1.04-2.75); 1.69 (1.01-2.87), and 1.61 (0.98-2.65), respectively.

Conclusion: Our findings suggest that adiposity trajectories, particularly central adiposity index of CI, could precisely predict the CVD risk. Consequently, preventive strategies should be tailored accordingly.

Keywords: adiposity indices; body mass index (BMI); body roundness index (BRI); cardiovascular disease (CVD); conicity index (CI); tehran lipid and glucose study (TLGS); trajectory; waist circumference (WC).

Figure 1

Flowchart of the study.

Figure 2

Forest plot of HRs (95% CIs) for adiposity indices (BMI, WC, CI, and BRI) at baseline for incidence CVD in total participants and subgroups according to the menopausal status. (A) Total participants; (B) Not reached menopause during follow ups; (C) Reached menopause during follow ups; (D) Menopause at baseline. BMI, Body Mass Index; WC, Waist circumference; CI, conicity index (CI); BRI, Body roundness index; CVD, cardiovascular disease.

Figure 3

Predicted trajectories of BMI, WC, CI and BRI during follow-ups. (A) BMI; (B) CI; (C); WC and (D) BRI. The trajectories are shown in solid line and capital letters. The proportions in each trajectory are shown above the graphs. BMI, Body Mass Index; WC, Waist circumference; CI, conicity index (CI); BRI, Body roundness index; CVD, cardiovascular disease.