title: Impact of metabolic disorders on the relation between overweight/obesity and incident myocardial infarction and ischaemic stroke in fertile women: a nationwide cohort study.
abstract: OBJECTIVE
  Whether overweight is a risk factor for cardiovascular disease in the absence of metabolic disorders remains under debate and is largely unexamined in young women. We evaluated the risk of myocardial infarction and ischaemic stroke in fertile women conditional on time-dependent presence of metabolic disorders.
  
  
  METHODS
  From nationwide registers we identified all normal weight (body mass index [BMI] ≥ 18.5 to <25 kg m(-2) and overweight (BMI ≥ 25 kg m(-2)) Danish women giving birth from 2004 to 2009. Using multivariable Poisson regression models adjusted for age, calendar year and smoking, the risk of the composite outcome of myocardial infarction and ischaemic stroke was assessed with metabolic disorders (i.e. hypertensive conditions, abnormal glucose metabolism and/or dyslipidaemia) included as time-dependent variables.
  
  
  RESULTS
  The population comprised 261,489 women with median age of 30.5 years (interquartile range = [27.3, 33.8]). Median follow-up was 5.6 years (interquartile range = [4.0, 6.8]). Compared with normal weight women without metabolic disorders (with an incidence rate [IR] of 17.0 [95% confidence interval {CI} = 14.5-20.0] events per 100,000 person-years), overweight women without metabolic disorders had no significantly increased risk, IR 22.6 (CI = 18.3-27.8), adjusted incidence rate ratio (IRR), 1.26 (CI = 0.97-1.65). For women with metabolic disorders, IR was 30.2 (CI = 18.8-48.6) and adjusted IRR 1.77 (CI = 1.07-2.93) in normal weight, while IR was 87.1 (CI = 67.6-112.2) and IRR 4.24 (CI = 5 3.11-5.79) in overweight.
  
  
  CONCLUSIONS
  The risk of myocardial infarction and ischaemic stroke was more strongly associated with the presence of metabolic disorders than with overweight per se in fertile women. Targeting prevention of metabolic disorders might be beneficial to reduce cardiovascular disease in overweight/obese young women.
authors: The Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.|The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors: S S
authors: SS
authors: Andersen
authors: The Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors: C
authors: C
authors: Andersson
authors: The Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors: S M
authors: SM
authors: Berger
authors: The Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors: T B
authors: TB
authors: Jensen
authors: Institute of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors: C T
authors: CT
authors: Torp-Pedersen
authors: The Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.|The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.|The Danish Heart Foundation, Copenhagen, Denmark.
authors: G H
authors: GH
authors: Gislason
authors: The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors: L
authors: L
authors: Køber
authors: The Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors: M D
authors: MD
authors: Schmiegelow
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002545:Brain Ischemia / Q000209:etiology* / Q000401:mortality; D005260:Female; D005298:Fertility; D006801:Humans; D008659:Metabolic Diseases / Q000150:complications* / Q000401:mortality; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D009765:Obesity / Q000150:complications / Q000401:mortality; D050177:Overweight / Q000150:complications* / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology* / Q000401:mortality
keywords: Cardiovascular disease; diabetes; dyslipidaemia; hypertension; obesity; young women