Association of Body Mass Index With Coronary Artery Calcium and Subsequent Cardiovascular Mortality

Abstract

Background: Obesity is associated with higher risk for coronary artery calcium (CAC), but the relationship between body mass index (BMI) and mortality is complex and frequently paradoxical. Methods: We analyzed BMI, CAC, and subsequent mortality using data from the CAC Consortium, a multi-centered cohort of individuals free of established cardiovascular disease (CVD) who underwent CAC testing. Mortality was assessed through linkage to the Social Security Death Index and cause of death from the National Death Index. Multivariable logistic regression was used to determine odds ratios for the association of clinically relevant BMI categories and prevalent CAC. Cox proportional hazards regression modeling was used to determine hazard ratios for coronary heart disease, CVD, and all-cause mortality according to categories of BMI and CAC. Results: Our sample included 36 509 individuals, mean age 54.1 (10.3) years, 34.4% female, median BMI 26.6 (interquartile range, 24.1–30.1), 46.6% had zero CAC, and 10.5% had CAC ≥400. Compared with individuals with normal BMI, the multivariable adjusted odds of CAC >0 were increased in those overweight (odds ratio, 1.13 [95% CI, 1.1–1.2]) and obese (odds ratio, 1.5 [95% CI, 1.4–1.6]). Over a median follow-up of 11.4 years, there were 1550 deaths (4.3%). Compared with normal BMI, obese individuals had a higher risk of coronary heart disease, CVD, and all-cause mortality while overweight individuals, despite a higher odds of CAC, showed no significant increase in mortality. In a sex-stratified analysis, the increase in coronary heart disease, CVD, and all-cause mortality in obese individuals appeared largely limited to men, and there was a lower risk of all-cause mortality in overweight women (hazard ratio, 0.79 [95% CI, 0.63–0.98]). Conclusions: In a large sample undergoing CAC scoring, obesity was associated with a higher risk of CAC and subsequent coronary heart disease, CVD, and all-cause mortality. However, overweight individuals did not have a higher risk of mortality despite a higher risk for CAC.

Serum OPG and RANKL Levels as Risk Factors for the Development of Cardiovascular Calcifications in End-Stage Renal Disease Patients in Hemodialysis

“…After the multivariate analysis, BMI was the only variable that kept its statistical and positive significance. This result comes in accordance with other studies which have associated BMI with VCs, performed both on the general population [ 42 , 43 ] and CKD patients [ 36 ]. This is the first study though to reveal BMI as a strong and independent predictor of MACs in hemodialysis patients, affirming its implication and importance.…”

“…It was positively correlated with the presence of AACs and a high calcification score. This result is also supported by Ozkok et al [ 43 ], where OPG/RANKL ratio values were higher both at baseline and after 1 year of follow-up, in the group of patients who showed a progression of CACs, compared to the non-progressive group. Its use though as a prognostic biomarker of VCs has not been evaluated, and since in our study sRANKL did not show any associations with VCs or any of the other variables, we could attribute the results regarding the association of OPG/RANKL with VCs to the presence of OPG in the equation and not to the ratio itself.…”

Traditional and novel cardiometabolic risk markers across strata of body mass index in young adults

“…Furthermore, the study found progression of CAC over a 5‐year period in 14.4% of middle‐aged adults with CACS = 0 at the initial scan. Newly published studies from the CAC consortium, an ongoing multicenter study, demonstrated increased prevalence of CAC in individuals with overweight and obesity compared to individuals with normal weight, and an overall CAC prevalence of 21.8% in individuals aged 30–39 years 29,30 . The CAC consortium study population was asymptomatic; however, had clinical indications for CAC scoring, most often hyperlipidemia or a family history of CVD, which might explain the high occurrence of elevated CACS.…”

“…Newly published studies from the CAC consortium, an ongoing multicenter study, demonstrated increased prevalence of CAC in individuals with overweight and obesity compared to individuals with normal weight, and an overall CAC prevalence of 21.8% in individuals aged 30–39 years. 29 , 30 The CAC consortium study population was asymptomatic; however, had clinical indications for CAC scoring, most often hyperlipidemia or a family history of CVD, which might explain the high occurrence of elevated CACS. The Bogalusa Heart study described the prevalence of fatty streaks and fibrous plaques in childhood and young adulthood by autopsy studies performed on individuals who had died from various causes, mostly accident or homicide.…”

Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study

“…On the other hand, it has also been suggested that subcutaneous adipose tissue dysfunction, characterized by insulin resistance, low plasma adiponectin, and increased ectopic fat deposits, is the initial damage that promotes CAD development [ 15 , 16 ]. Moreover, it has been observed that body fat is a pathophysiological modulator related to the incidence and progression of CAC [ 17 ]. Direct measurement of ectopic fat requires expensive equipment, inaccessible to clinical practice.…”