title: Obesity and Subtypes of Incident Cardiovascular Disease.
abstract: Obesity is a risk factor for various subtypes of cardiovascular disease (CVD), including coronary heart disease (CHD), heart failure (HF), and stroke. Nevertheless, there are limited comparisons of the associations of obesity with each of these CVD subtypes, particularly regarding the extent to which they are unexplained by traditional CVD mediators.
  
  
  
  We followed 13 730 participants in the Atherosclerosis Risk in Communities (ARIC) study who had a body mass index ≥18.5 and no CVD at baseline (visit 1, 1987-1989). We compared the association of higher body mass index with incident HF, CHD, and stroke before and after adjusting for traditional CVD mediators (including systolic blood pressure, diabetes mellitus, and lipid measures). Over a median follow-up of 23 years, there were 2235 HF events, 1653 CHD events, and 986 strokes. After adjustment for demographics, smoking, physical activity, and alcohol intake, higher body mass index had the strongest association with incident HF among CVD subtypes, with hazard ratios for severe obesity (body mass index ≥35 versus normal weight) of 3.74 (95% CI 3.24-4.31) for HF, 2.00 (95% CI 1.67-2.40) for CHD, and 1.75 (95% CI 1.40-2.20) for stroke (P<0.0001 for comparisons of HF versus CHD or stroke). Further adjustment for traditional mediators fully explained the association of higher body mass index with CHD and stroke but not with HF (hazard ratio 2.27, 95% CI 1.94-2.64).
  
  
  
  The link between obesity and HF was stronger than those for other CVD subtypes and was uniquely unexplained by traditional risk factors. Weight management is likely critical for optimal HF prevention, and nontraditional pathways linking obesity to HF need to be elucidated.
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD cndumel2@jhmi.edu.
authors.forename: Chiadi E
authors.initials: CE
authors.lastname: Ndumele
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Natalie
authors.initials: N
authors.lastname: Bello
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Gary
authors.initials: G
authors.lastname: Gerstenblith
authors.affiliation: Michael E DeBakey Veterans Affairs Hospital, Houston, TX Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Division of Cardiology, Brigham and Womens' Hospital, Boston, MA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D057185:Sedentary Behavior; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: coronary heart disease; epidemiology; heart failure; obesity; stroke