Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records.
Journal
Epidemiology (Cambridge, Mass.)
ISSN: 1531-5487
Titre abrégé: Epidemiology
Pays: United States
ID NLM: 9009644
Informations de publication
Date de publication:
01 09 2021
01 09 2021
Historique:
entrez:
4
8
2021
pubmed:
5
8
2021
medline:
30
9
2021
Statut:
ppublish
Résumé
Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45-69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group. Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (-0.2% to 1.7%)] and the weight gain group [RD = 0.7% (-0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = -1.4% (-2.4% to -0.6%)] but not of stroke. When we assumed that chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals. Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838.
Sections du résumé
BACKGROUND
Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD.
METHODS
We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45-69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group.
RESULTS
Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (-0.2% to 1.7%)] and the weight gain group [RD = 0.7% (-0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = -1.4% (-2.4% to -0.6%)] but not of stroke. When we assumed that chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals.
CONCLUSION
Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838.
Identifiants
pubmed: 34348396
doi: 10.1097/EDE.0000000000001393
pii: 00001648-202109000-00019
pmc: PMC8318567
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
744-755Subventions
Organisme : Medical Research Council
ID : MC_UU_00006/1
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 204841/Z/16/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_13041
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K006584/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/S003754/1
Pays : United Kingdom
Organisme : Department of Health
ID : BRC714A/HI/RW/101440
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 204928/Z/16/Z
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/14/76/30933
Pays : United Kingdom
Organisme : Chief Scientist Office
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/18/5/33319
Pays : United Kingdom
Organisme : Department of Health
ID : 19RX02
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0902393
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
Rock CL, Flatt SW, Pakiz B, et al. Weight loss, glycemic control, and cardiovascular disease risk factors in response to differential diet composition in a weight loss program in type 2 diabetes: a randomized controlled trial. Diabetes Care. 2014;37:1573–1580.
Bohula EA, Wiviott SD, McGuire DK, et al.; CAMELLIA–TIMI 61 Steering Committee and Investigators. Cardiovascular safety of lorcaserin in overweight or obese patients. N Engl J Med. 2018;379:1107–1117.
Khera R, Pandey A, Chandar AK, et al. Effects of weight-loss medications on cardiometabolic risk profiles: a systematic review and network meta-analysis. Gastroenterology. 2018;154:1309–1319.e7.
Ma C, Avenell A, Bolland M, et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017;359:j4849.
Ackermann RT, Liss DT, Finch EA, et al. A randomized comparative effectiveness trial for preventing type 2 diabetes. Am J Public Health. 2015;105:2328–2334.
Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;359:145–54.
Mongraw-Chaffin ML, Peters SAE, Huxley RR, Woodward M. The sex-specific association between BMI and coronary heart disease: a systematic review and meta-analysis of 95 cohorts with 1·2 million participants. Lancet Diabetes Endocrinol. 2015;3:437–449.
Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440–2450.
Dickerman BA, García-Albéniz X, Logan RW, Denaxas S, Hernán MA. Avoidable flaws in observational analyses: an application to statins and cancer. Nat Med. 2019;25:1601–1606.
Hernán MA, Robins JM. Using big data to emulate a target trial when a randomized trial is not available. Am J Epidemiol. 2016;183:758–764.
Danaei G, García Rodríguez LA, Cantero OF, Logan RW, Hernán MA. Electronic medical records can be used to emulate target trials of sustained treatment strategies. J Clin Epidemiol. 2018;96:12–22.
Hernán MA, Robins JM. Causal Inference: What If. Chapman & Hall/CRC; 2021.
Nanri A, Mizoue T, Takahashi Y, Noda M, Inoue M, Tsugane S; Japan Public Health Center-based Prospective Study Group. Weight change and all-cause, cancer and cardiovascular disease mortality in Japanese men and women: the Japan Public Health Center-Based Prospective Study. Int J Obes (Lond). 2010;34:348–356.
Mulligan AA, Lentjes MAH, Luben RN, Wareham NJ, Khaw KT. Weight change and 15 year mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. Eur J Epidemiol. 2018;33:37–53.
Stevens J, Erber E, Truesdale KP, Wang CH, Cai J. Long- and short-term weight change and incident coronary heart disease and ischemic stroke: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2013;178:239–248.
Chei CL, Iso H, Yamagishi K, et al. Body mass index and weight change since 20 years of age and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based Study. Int J Obes. 2008;32:144–151.
Taubman SL, Robins JM, Mittleman MA, Hernán MA. Intervening on risk factors for coronary heart disease: an application of the parametric g-formula. Int J Epidemiol. 2009;38:1599–1611.
Danaei G, Robins JM, Young JG, Hu FB, Manson JE, Hernán MA. Weight loss and coronary heart disease: sensitivity analysis for unmeasured confounding by undiagnosed disease. Epidemiology. 2016;27:302–310.
Wannamethee SG, Shaper AG, Walker M. Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes. J Epidemiol Community Health. 2005;59:134–139.
Douglas IJ, Bhaskaran K, Batterham RL, Smeeth L. Bariatric surgery in the United Kingdom: a cohort study of weight loss and clinical outcomes in routine clinical care. PLoS Med. 2015;12:e1001925.
Yarnell JW, Patterson CC, Thomas HF, Sweetnam PM. Comparison of weight in middle age, weight at 18 years, and weight change between, in predicting subsequent 14 year mortality and coronary events: caerphilly Prospective Study. J Epidemiol Community Health. 2000;54:344–348.
Koudstaal S, Pujades-Rodriguez M, Denaxas S, et al. Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people. Eur J Heart Fail. 2017;19:1119–1127.
Denaxas S, Gonzalez-Izquierdo A, Direk K, et al. UK phenomics platform for developing and validating electronic health record phenotypes: CALIBER. JAMIA. 2019. doi: 10.1093/jamia/ocz105
doi: 10.1093/jamia/ocz105
Kim ES, Jeong JS, Han K, et al. Impact of weight changes on the incidence of diabetes mellitus: a Korean nationwide cohort study. Sci Rep. 2018;8:3735.
Katsoulis M, Lai GA, Kipourou DK, et al. How to estimate the association between change in a risk factor and a health outcome? ArXiv (arxiv.org/abs/2012.11291)
Hernán MA, Taubman SL. Does obesity shorten life? The importance of well-defined interventions to answer causal questions. Int J Obes (Lond). 2008;32(3 Suppl):S8–14.
Rojas-Saunero LP, Hilal S, Murray EJ, Logan RW, Ikram MA, Swanson SA. Hypothetical blood-pressure-lowering interventions and risk of stroke and dementia. Eur J Epidemiol. 2021;36:69–79.
Dahabreh IJ, Hernán MA. Extending inferences from a randomized trial to a target population. Eur J Epidemiol. 2019;34:719–722.
Weight loss plan suggested by NHS (online). Available at: https://www.nhs.uk/live-well/healthy-weight/start-the-nhs-weight-loss-plan/ .
Curry SJ, Krist AH, Owens DK, et al.; US Preventive Services Task Force. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US preventive services task force recommendation statement. JAMA. 2018;320:1163–1171.
Meschia JF, Bushnell C, Boden-Albala B, et al.; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:3754–3832.