Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium.
OBJECTIVE
To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians.


METHODS
Pooled analyses of 20 prospective cohorts in Asia, including data from 835,082 east Asians and 289,815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability.


METHODS
General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh).


METHODS
1,124,897 men and women (mean age 53.4 years at baseline).


METHODS
Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes.


RESULTS
49,184 cardiovascular deaths (40,791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12).


CONCLUSIONS
Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.
Department of Population Health, New York University School of Medicine, New York, NY, USA.
Yu
Y
Chen
Wade K
WK
Copeland
Rajesh
R
Vedanthan
Eric
E
Grant
Jung Eun
JE
Lee
Dongfeng
D
Gu
Prakash C
PC
Gupta
Kunnambath
K
Ramadas
Manami
M
Inoue
Shoichiro
S
Tsugane
Akiko
A
Tamakoshi
Yu-Tang
YT
Gao
Jian-Min
JM
Yuan
Xiao-Ou
XO
Shu
Kotaro
K
Ozasa
Ichiro
I
Tsuji
Masako
M
Kakizaki
Hideo
H
Tanaka
Yoshikazu
Y
Nishino
Chien-Jen
CJ
Chen
Renwei
R
Wang
Keun-Young
KY
Yoo
Yoon-Ok
YO
Ahn
Habibul
H
Ahsan
Wen-Harn
WH
Pan
Chung-Shiuan
CS
Chen
Mangesh S
MS
Pednekar
Catherine
C
Sauvaget
Shizuka
S
Sasazuki
Gong
G
Yang
Woon-Puay
WP
Koh
Yong-Bing
YB
Xiang
Waka
W
Ohishi
Takashi
T
Watanabe
Yumi
Y
Sugawara
Keitaro
K
Matsuo
San-Lin
SL
You
Sue K
SK
Park
Dong-Hyun
DH
Kim
Faruque
F
Parvez
Shao-Yuan
SY
Chuang
Wenzhen
W
Ge
Betsy
B
Rolland
Dale
D
McLerran
Rashmi
R
Sinha
Mark
M
Thornquist
Daehee
D
Kang
Ziding
Z
Feng
Paolo
P
Boffetta
Wei
W
Zheng
Jiang
J
He
John D
JD
Potter
D001208:Asia / Q000453:epidemiology; D044466:Asian People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality* / Q000517:prevention & control; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality; D005202:Asia, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000401:mortality; D008019:Life Style / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology / Q000401:mortality; D020521:Stroke / Q000208:ethnology / Q000401:mortality