Severe obesity, heart disease, and death among white, african american, and hispanic postmenopausal women
Department of Medicine, Division of Preventive and Behavioral Medicine
Behavior and Behavior Mechanisms | Clinical Epidemiology | Community Health | Community Health and Preventive Medicine | Public Health | Women's Health
OBJECTIVE: To compare mortality, nonfatal coronary heart disease (CHD), and congestive heart failure (CHF) risk across BMI categories in white, African American, and Hispanic women, with a focus on severe obesity (BMI >/= 40), and examine heterogeneity in weight-related CHD risk.
DESIGN AND METHODS: Among 156,775 Women's Health Initiative observational study and clinical trial participants (September 1993-12 September 2005), multivariable Cox models estimated relative risk for mortality, CHD, and CHF. CHD incidence was calculated by anthropometry, race, and cardiovascular risk factors (CVRF).
RESULTS: Mortality, nonfatal CHD, and CHF incidence generally rose with BMI category. For severe obesity versus normal BMI, hazard ratios (HRs, 95% confidence interval) for mortality were 1.97 (1.77-2.20) in white, 1.55 (1.20-2.00) in African American, and 2.59 (1.55-4.31) in Hispanic women; for CHD, HRs were 2.05 (1.80-2.35), 2.24 (1.57-3.19), and 2.95 (1.60-5.41) respectively; for CHF, HRs were 5.01 (4.33-5.80), 3.60 (2.30-5.62), and 6.05 (2.49-14.69). CVRF variation resulted in substantial variation in CHD rates across BMI categories, even in severe obesity. CHD incidence was similar by race/ethnicity when differences in BMI or CVRF were accounted for.
CONCLUSIONS: Severe obesity increases mortality, nonfatal CHD, and CHF risk in women of diverse race/ethnicity. CVRF heterogeneity contributes to variation in CHD incidence even in severe obesity.
cardiovascular diseases/epidemiology, cardiovascular diseases/etiology, longitudinal studies, obesity, morbid/complications, obesity, morbid/epidemiology, obesity/epidemiology, obesity/complications
DOI of Published Version
McTigue KM, Chang YF, Eaton C, Garcia L, Johnson KC, Lewis CE, Liu S, Mackey RH, Robinson J, Rosal MC, Snetselaar L, Valoski A, Kuller LH. Severe obesity, heart disease, and death among white, african american, and hispanic postmenopausal women. Obesity (Silver Spring). 2012 Dec 12. doi:10.1002/oby.20224. Link to article on publisher's site
Obesity (Silver Spring, Md.)
McTigue, Kathleen M.; Chang, Yue-Fang; Eaton, Charles B.; Garcia, Lorena; Johnson, Karen C.; Lewis, Cora E.; Liu, Simin; Mackey, Rachel H.; Robinson, Jennifer; Rosal, Milagros C.; Snetselaar, Linda G.; Valoski, Alice; and Kuller, Lewis H., "Severe obesity, heart disease, and death among white, african american, and hispanic postmenopausal women" (2014). UMass Worcester Prevention Research Center Publications. 17.