Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome

TY - JOUR

T1 - Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome

AU - Thomsen, Mette

AU - Nordestgaard, Børge G

PY - 2014/1

Y1 - 2014/1

N2 - IMPORTANCE Overweight and obesity likely cause myocardial infarction (MI) and ischemic heart disease (IHD); however, whether coexisting metabolic syndrome is a necessary condition is unknown. OBJECTIVE To test the hypothesis that overweight and obesity with and without metabolic syndrome are associated with increased risk of MI and IHD. DESIGN, SETTING, AND PARTICIPANTS We examined 71 527 individuals from the Copenhagen General Population Study and categorized them according to body mass index (BMI) as normal weight, overweight, or obese and according to absence or presence of metabolic syndrome. MAINOUTCOMES ANDMEASURES Hazard ratios for incident MI and IHD according to combinations of BMI category and absence or presence of metabolic syndrome. RESULTS During a median of 3.6 years' follow-up, we recorded 634 incident MI and 1781 incident IHD events. For MI, multivariable adjusted hazard ratios vs normal weight individuals without metabolic syndrome were 1.26 (95% CI, 1.00-1.61) in overweight and 1.88 (95% CI, 1.34-2.63) in obese individuals without metabolic syndrome and 1.39 (95% CI, 0.96-2.02) in normal weight, 1.70 (95% CI, 1.35-2.15) in overweight, and 2.33 (95% CI, 1.81-3.00) in obese individuals with metabolic syndrome. For IHD, results were similar but attenuated. Normal weight vs overweight vs obesity and presence vs absence of metabolic syndrome did not interact on risk of MI or IHD (P =.90 and P =.44). Among individuals both with and without metabolic syndrome there were increasing cumulative incidences of MI and IHD from normal weight through overweight to obese individuals (log-rank trend P =.006 to P <.001). Although the multivariable adjusted hazard ratio for MI in individuals with vs without metabolic syndrome was 1.54 (95% CI, 1.32-1.81) across all BMI categories, addition of metabolic syndrome to a multivariable model including BMI and other clinical characteristics improved the Harell C-statistic only slightly for risk of MI (comparison P =.03) but not for IHD (P =.41). CONCLUSIONS AND RELEVANCE These findings suggest that overweight and obesity are risk factors for MI and IHD regardless of the presence or absence of metabolic syndrome and that metabolic syndrome is no more valuable than BMI in identifying individuals at risk.

AB - IMPORTANCE Overweight and obesity likely cause myocardial infarction (MI) and ischemic heart disease (IHD); however, whether coexisting metabolic syndrome is a necessary condition is unknown. OBJECTIVE To test the hypothesis that overweight and obesity with and without metabolic syndrome are associated with increased risk of MI and IHD. DESIGN, SETTING, AND PARTICIPANTS We examined 71 527 individuals from the Copenhagen General Population Study and categorized them according to body mass index (BMI) as normal weight, overweight, or obese and according to absence or presence of metabolic syndrome. MAINOUTCOMES ANDMEASURES Hazard ratios for incident MI and IHD according to combinations of BMI category and absence or presence of metabolic syndrome. RESULTS During a median of 3.6 years' follow-up, we recorded 634 incident MI and 1781 incident IHD events. For MI, multivariable adjusted hazard ratios vs normal weight individuals without metabolic syndrome were 1.26 (95% CI, 1.00-1.61) in overweight and 1.88 (95% CI, 1.34-2.63) in obese individuals without metabolic syndrome and 1.39 (95% CI, 0.96-2.02) in normal weight, 1.70 (95% CI, 1.35-2.15) in overweight, and 2.33 (95% CI, 1.81-3.00) in obese individuals with metabolic syndrome. For IHD, results were similar but attenuated. Normal weight vs overweight vs obesity and presence vs absence of metabolic syndrome did not interact on risk of MI or IHD (P =.90 and P =.44). Among individuals both with and without metabolic syndrome there were increasing cumulative incidences of MI and IHD from normal weight through overweight to obese individuals (log-rank trend P =.006 to P <.001). Although the multivariable adjusted hazard ratio for MI in individuals with vs without metabolic syndrome was 1.54 (95% CI, 1.32-1.81) across all BMI categories, addition of metabolic syndrome to a multivariable model including BMI and other clinical characteristics improved the Harell C-statistic only slightly for risk of MI (comparison P =.03) but not for IHD (P =.41). CONCLUSIONS AND RELEVANCE These findings suggest that overweight and obesity are risk factors for MI and IHD regardless of the presence or absence of metabolic syndrome and that metabolic syndrome is no more valuable than BMI in identifying individuals at risk.

KW - Adult

KW - Aged

KW - Body Mass Index

KW - Case-Control Studies

KW - Cross-Sectional Studies

KW - Denmark

KW - Female

KW - Humans

KW - Male

KW - Metabolic Syndrome X

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Myocardial Ischemia

KW - Obesity

KW - Overweight

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Risk Factors

U2 - 10.1001/jamainternmed.2013.10522

DO - 10.1001/jamainternmed.2013.10522

M3 - Journal article

C2 - 24217719

SN - 2168-6106

VL - 174

SP - 15

EP - 22

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

IS - 1

ER -