title: Trajectories of body mass index before the diagnosis of cardiovascular disease: a latent class trajectory analysis.
abstract: Patients with cardiovascular disease (CVD) are a heterogeneous group regarding their body mass index (BMI) levels at the time of diagnosis. To address the heterogeneity of CVD, we examined the trajectories of change in body mass index (BMI) and in other cardio-metabolic risk factors before CVD diagnosis. The study included 6126 participants from the prospective population-based Rotterdam Study, followed over 22 years with clinical examinations every 4 years. Latent class trajectory analysis and mixed-effect models were used to develop trajectories of BMI and other cardio-metabolic risk factors respectively. During follow-up, 1748 participants developed CVD, among whom we identified 3 distinct BMI trajectories. The majority of participants (n = 1534, 87.8 %) had steady BMI levels during follow-up, comprising the "stable weight" group. This group showed decrease in mean high-density lipoprotein (HDL) cholesterol over time. The second group, the "progressive weight gain" group (n = 112, 6.4 %), showed a progressive increase in BMI levels. In this group, mean waist circumference increased, mean HDL cholesterol decreased and mean fasting glucose levels were fluctuating over follow-up. In the third group, the "progressive weight loss" group (n = 102, 5.8 %), BMI levels decreased during follow-up. This group showed a decrease in mean waist circumference and in fasting glucose. In conclusion, the majority of individuals who developed CVD had a stable weight during follow-up, suggesting that BMI alone is not a good indicator for identifying middle-aged and elderly individuals at high risk of CVD. Waist circumference, HDL cholesterol, and glucose trajectories differed between the identified BMI subgroups, further highlighting that CVD is a heterogeneous disease with different pathophysiological pathways.
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Klodian
authors.initials: K
authors.lastname: Dhana
authors.affiliation: Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Vistisen
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.|Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.|Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. m.kavousi@erasmusmc.nl.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kavousi
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D008076:Cholesterol, HDL; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000503:physiopathology*; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D055105:Waist Circumference; D015430:Weight Gain
chemical_list: D008076:Cholesterol, HDL
keywords: Blood pressure; Body mass index; Cardiovascular disease; Glucose; Lipids; Obesity/physiopathology