Association between body mass index and risk of cardiovascular disease-specific mortality among adults with hypertension in Shanghai, China

Body weight, weight change and the risk of cardiovascular disease in patients with hypertension: a primary-care cohort study

BACKGROUND/OBJECTIVES

Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension are not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension.

SUBJECTS/METHODS

Our Data were drawn from the medical records of primary-care institutions in China. A total of 24,750 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight ( < 18.5 kg/m2), healthy weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2) and obesity ( ≥ 25.0 kg/m2). Weight change over 12 months was divided into: gain >4%, gain 1-4%, stable (-1 to 1%), loss 1-4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) between BMI, weight change and the risk of CVD.

RESULTS

After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR = 1.48, 95% CI: 1.19-1.85). Higher risks were seen in participants with loss ≥4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR = 1.33, 95% CI: 1.04-1.70; gain >4%: HR = 1.36, 95% CI: 1.04-1.77).

CONCLUSION

Obesity and weight change of loss ≥4% and gain >4% were related to higher risks of CVD. Close monitoring and appropriate interventions aimed at achieving an optimal weight are needed to prevent adverse cardiovascular outcomes for patients with hypertension.

Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study

BACKGROUND

Effects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA).

METHODS

Hypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age.

RESULTS

2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m²), 1164 overweight (25-29.9 kg/m²) and 670 obesity (≥30 kg/m²). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01-2.32, P = 0.047) and obesity groups (1.85, 1.19-2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04-2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030).

CONCLUSIONS

BMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.

Association of body mass index with risk of prediabetes in Chinese adults: a population-based cohort study

Aims/Introduction

Overweight and obesity in adults are strongly associated with an increased risk of prediabetes, and this study set out to gain a better understanding of the optimal body mass index (BMI) range for assessing the risk of prediabetes in the Chinese population.

Materials and Methods

The cohort study included 100,309 Chinese adults who underwent health screening. Participants were divided into six groups based on the cut‐off point for BMI recommended by the World Health Organization (underweight: <18.5 kg/m², normal‐weight: 18.5–24.9 kg/m², pre‐obese: 25.0–29.9 kg/m², obese class I: 30.0–34.9 kg/m², obese class II: 35.0–39.9 kg/m², and obese class III ≥40 kg/m²). The association of BMI with prediabetes and the shape of the correlation were modeled using multivariate Cox regression and restricted cubic spline regression, respectively.

Results

In the multivariate Cox regression model, with normal weight as the control group, underweight people had a lower risk of developing prediabetes, whereas obese and pre‐obese people had a higher risk of prediabetes. Additionally, in the restricted cubic spline model, we found that the association of BMI with prediabetes follows a positive dose–response relationship, but does not conform to the pattern of obesity paradox. Among the general population in China, a BMI of 23.03 kg/m² might be a potential intervention threshold for prediabetes.

Conclusions

The national cohort study found that the association of BMI with prediabetes follows a positive dose–response relationship, rather than a pattern of obesity paradox. For Chinese people with normal weight, more attention should be paid to glucose metabolism when BMI exceeds 23.03 kg/m².

Construction of a risk assessment model of cardiovascular disease in a rural Chinese hypertensive population based on lasso-Cox analysis

Many assessments have been used to predict cardiovascular risks in the general population, but their applicability in patients with hypertension needs to be further evaluated. In the current study, a cardiovascular risk assessment model was constructed in a hypertensive population. This prospective cohort study was conducted with cardiovascular examinations in rural northeast China in 2012 and 2013, and followed up to collect cardiovascular events in 2015 and 2018. Data were derived from 4763 hypertensive patients who were free of cardiovascular disease (CVD) at baseline and completed follow‐up. After lasso regression was used to screen for risk factors of CVD at baseline, a multivariate Cox regression risk model was established and a nomogram was developed. The model was validated using an independent test set (one third of data not used for model building). Among 4763 patients, 354 (7.43%) had a cardiovascular event during a median follow‐up of 4.66 years. Nine risk factors were screened by lasso regression, including sex, age, current smoking, body mass index (BMI), history of transient ischemic attack (TIA), family history of hypertension, family history of stroke, physical labor intensity, and high low‐density lipoprotein cholesterol (LDL‐C). The c‐index of the CVD model was 0.707, and that of an updated model with baseline blood pressure was 0.732. In the validated cohort the respective c‐indexes were 0.665 and 0.714. An assessment model of CVD risk was established in a hypertensive population which may provide an original prevention strategy for hypertensive populations in rural China, and further reduce the CVD burden.

Combined Effect of Famine Exposure and Obesity Parameters on Hypertension in the Midaged and Older Adult: A Population-Based Cross-Sectional Study

OBJECTIVES

Undernutrition early in life may increase the incidence of adverse effects on adult health. The relations between undernutrition and obesity parameters (body mass index (BMI) and WC (waist circle)) and hypertension were often contradictory. Our study is aimed at identifying the combined effects of famine exposure and obesity parameters on hypertension in middle-aged and older Chinese.

DESIGN

A population-based cross-sectional study. Setting. Data were selected from the China Health and Retirement Longitudinal Study Wave2011 (CHARLS Wave2011). Participants. The sample included 12945 individuals aged 45 to 96. Main Outcome Measurements. The study analyzed data from 12945 middle-aged and older Chinese selected from CHARLS Wave2011. Differences between baseline characteristics and famine exposure/BMI levels/WC levels were evaluated using the t-, Chi-square- (χ 2-), and F-test. Then, the difference in the prevalence of hypertension between baseline characteristics was estimated by the t- and χ 2-test. Finally, multivariable-adjusted logistic regression models were used to explore the associations of famine exposure and obesity parameters with odds of prevalence of hypertension.

RESULTS

Among the 12945 participants, 1548 (11.96%) participants had been exposed to the Chinese famine during the fetal group, whereas 5101 (39.41%) participants and 4362 (33.70%) participants had been exposed to the famine during childhood and adolescence/adult group, respectively. Regarding the participants with BMI levels, 3746 (28.94%) were overweight, and 1465 (11.32%) were obese, whereas 5345 (41.29%) of the participants with WC levels were obese, respectively. Furthermore, 1920 (31.17%) had hypertension in males and 2233 (32.91%) in females. In multivariable-adjusted models, famine exposure and obesity parameters were related with prevalence of hypertension independently in total populations ((1) model threec, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.27; 95% CI 1.08, 1.49); childhood-exposed vs. no-exposed group (OR1.64; 95% CI 1.44, 1.87); the adolescence/adult-exposed vs. no-exposed group (OR3.06; 95% CI 2.68, 3.50); P for trend < 0.001; (2) model threee, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.25; 95% CI 1.06, 1.47); childhood-exposed vs. no-exposed group (OR1.52; 95% CI 1.34, 1.73); the adolescence/adult-exposed vs. no-exposed group (OR2.66; 95% CI 2.33, 3.03); P for trend < 0.001; (3) model threeg, BMI levels with prevalence of hypertension: overweight vs. normal (OR1.75; 95% CI 1.60, 1.91); obesity vs. normal (OR2.79; 95% CI 2.48, 3.15); P for trend < 0.001; (4) WC levels with prevalence of hypertension: overweight vs. normal (OR1.42; 95% CI 1.36, 1.48)). When stratified by sex, results in both males and females were mostly similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal BMI/WC levels and no-exposed famine group, all groups trended towards higher odds of prevalence of hypertension (the greatest increase in odds, adolescence/adult-exposed group with obesity in BMI levels: (OR8.13; 95% CI 6.18, 10.71); adolescence/adult-exposed group with obesity in WC levels: (OR6.36; 95% CI 5.22, 7.75); P for interaction < 0.001). When stratified by sex, the results in both males and females were also similar to those in the total population.

CONCLUSION

Our data support a strongly positive combined effect of famine exposure and obesity parameters on hypertension in middle-aged and elderly Chinese.

Structure and Function of Mitochondria-Associated Endoplasmic Reticulum Membranes (MAMs) and Their Role in Cardiovascular Diseases

Abnormal function of suborganelles such as mitochondria and endoplasmic reticulum often leads to abnormal function of cardiomyocytes or vascular endothelial cells and cardiovascular disease (CVD). Mitochondria-associated membrane (MAM) is involved in several important cellular functions. Increasing evidence shows that MAM is involved in the pathogenesis of CVD. MAM mediates multiple cellular processes, including calcium homeostasis regulation, lipid metabolism, unfolded protein response, ROS, mitochondrial dynamics, autophagy, apoptosis, and inflammation, which are key risk factors for CVD. In this review, we discuss the structure of MAM and MAM-associated proteins, their role in CVD progression, and the potential use of MAM as the therapeutic targets for CVD treatment.