CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 10th, 2011

Obesity and Cardiovascular Risk: Does Size Matter?

A very large new study finds that obesity — no matter how it is calculated — is not an important independent predictor of cardiovascular disease. A report from the Emerging Risk Factors Collaboration published online in the Lancet analyzed individual records from more than 220,000 people without known cardiovascular disease and found that none of the traditional methods to categorize obesity — BMI, waist circumference, and waist-to-hip ratio — provided significant additional information about CV risk beyond that already provided by systolic blood pressure, diabetes, and lipids.

The authors wrote that their finding “does not, of course, diminish the importance of adiposity as a major modifiable determinant of cardiovascular disease” but that “because excess adiposity is a major determinant of the intermediate risk factors… our findings underscore the importance of controlling adiposity to help prevent cardiovascular disease.” The authors also say that their results “reliably refute previous recommendations to adopt baseline waist-to-hip ratio instead of BMI as the principal clinical measure of adiposity.”

In an accompanying comment, Rachel Huxley and David Jacobs Jr. write that “BMI continues to be useful as an indicator of adiposity” and should be “used with good clinical judgment.” However, they note, “size still matters… but not in the way we once thought.”

Categories: Prevention
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4 Responses to “Obesity and Cardiovascular Risk: Does Size Matter?”

  1. Susan Cheng, MD says:
    March 11, 2011 at 12:58 am

    Interesting, and I wonder if this is actually more of a time-dependent effect that they’re seeing, since we know that BMI predisposes to hypertension more than the other way around — such that hypertension typically develops later in life (closer to the event) whereas greater BMI has likely been around for longer (farther away from the event).

  2. J Vann, BSC says:
    March 11, 2011 at 4:47 pm

    Study implies A does not predict B. But says authors, A is a “major determinate” of B. Huh? Speed is a major determinate who makes the team but speed has no predictability of who makes the team. Still can’t understand, can anyone elucidate?

  3. Susan Cheng, MD says:
    March 11, 2011 at 11:01 pm

    Agree this can be confusing. I think they are trying to say that A (body size) is a major determinant of B (CVD) — but, when also accounting for C (other risk factors), the degree to which A predicts B appears less important. Or, skating fast is a major determinant of who makes the hockey team — but, when you also account for who can actually get the puck in the net, then scoring skills count for more (although speed and scoring often go together, they don’t always). Hope that helps.

  4. William L Blanchet, MD says:
    March 14, 2011 at 9:22 pm

    I appreciate an honest study.

    We love to use obesity as the whipping boy for our inability to accurately predict coronary risk based upon traditional risk factors alone. As more people are obese than there used to be, this excuse is even more useful that it used to be.

    As obesity has increased over the last decade, the incidence of coronary death has decreased. How can we reconcile this finding?

    Yes, obesity is associated with increased risk of diabetes, hypertension, dyslipidemia, and sleep apnea. It is also associated with larger coronary arteries which can accommodated more thrombus without obstructing blood flow.

    Certainly obesity is not a good idea, however to exaggerate its role in coronary disease gives undue comfort to those not suffering from this malady.