Association of Obesity or Weight Change With Coronary Heart Disease Among Young Adults in South Korea

Abstract

IMPORTANCE Previous studies have shown a U-or J-shaped association of body mass index (BMI) or change in BMI with coronary heart disease (CHD) among middle-aged and elderly adults. However, whether a similar association exists among young adults is unclear. OBJECTIVE To determine whether an association exists between BMI or BMI change with CHD among young adults. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal study used data obtained by the Korean National Health Insurance Service from 2002 to 2015. The study population comprised 2 611 450 men and women aged between 20 and 39 years who underwent 2 health examinations, the first between 2002 and 2003 and the second between 2004 and 2005. EXPOSURES World Health Organization Western Pacific Region guideline BMI categories of underweight, normal weight, overweight, obese grade 1, and obese grade 2 derived during the first health examination and change in BMI calculated during the second health examination. MAIN OUTCOMES AND MEASURES Body mass index (calculated as weight in kilograms divided by height in meters squared). Absolute risks (ARs), adjusted hazard ratios (aHRs), and 95% CIs for acute myocardial infarction or CHD during follow-up from 2006 to 2015. RESULTS Data from 1 802 408 men with a mean (SD) age of 35.1 (4.8) years and 809 042 women with a mean (SD) age of 32.5 (6.3) years were included. The mean (SD) BMI was 23.2 (3.2) for the total population, 24.0 (3.0) for men, and 21.4 (2.9) for women. Compared with normal weight men, overweight (AR, 1.38%; aHR, 1.18 [95% CI, 1.14-1.22]), obese grade 1 (AR, 1.86%; aHR, 1.45 [95% CI, 1.41-1.50]), and obese grade 2 (AR, 2.69%; aHR, 1.97 [95% CI, 1.86-2.08]) men had an increased risk of CHD (P < .001 for trend). Similarly, compared with normal weight women, overweight (AR, 0.77%; aHR, 1.34 [95% CI, 1.24-1.46]), obese grade 1 (AR, 0.95%; aHR, 1.52 [95% CI, 1.39-1.66]), and obese grade 2 (AR, 1.01%; aHR, 1.64 [95% CI, 1.34-2.01]) women had an increased risk of CHD (P < .001 for trend). Compared with participants who maintained their weight at normal levels, those who became obese had elevated CHD risk among men (0.35% increase in AR; aHR, 1.35 [95% CI, 1.17-1.55]) and women (0.13% increase in AR; aHR, 1.31 [95% CI, 0.95-1.82]). Weight loss to normal levels among obese participants was associated with reduced CHD risk for men (0.58% decrease in AR; aHR, 0.77 [95% CI, 0.64-0.94]) and women (0.57% decrease in AR; aHR, 0.66 [95% CI, 0.45-0.98]). CONCLUSIONS AND RELEVANCE Obesity and weight gain were associated with elevated risk of CHD among young adults in this study. Studies that prospectively determine the association between weight change and CHD risk are needed to validate these findings.

Pre-existing Depression among Newly Diagnosed Dyslipidemia Patients and Cardiovascular Disease Risk

“…Third, the definition of CVD could not be validated by medical records. Although the operational definition for CVD was adopted from previous studies that also used the NHIS database [11,12], future studies with a narrower definition of CVD, perhaps by using procedural codes for cardiovascular interventions or coronary artery bypass grafting operations are needed. Fourth, we could not adjust for certain potential confounders such as education due to the lack of information.…”

“…The definition of depression was adapted from another study [10]. CVD was defined when a participant was hospitalized for at least 2 days or died due to CVD, which was adapted from previous studies that used the NHIS database [11,12]. CVD included CHD (ICD-10 codes I20-I25) and stroke (ICD-10 codes I60-I69).…”

Association of Blood Pressure Classification in Korean Young Adults According to the 2017 American College of Cardiology/American Heart Association Guidelines With Subsequent Cardiovascular Disease Events

“…A CVD event was defined as 2 or more days of hospitalization or death due to the International Classification of Diseases, Tenth Revision (ICD-10) codes pertaining to CVD. 17,18 Upon admission, the NHIS requires physicians to designate ICD-10 codes for which the patient was hospitalized. Furthermore, causes of death were also determined by ICD-10 codes determined by the attending physician.…”

“…34 Second, the operational definition of CVD may be prone to misdiagnosis, as evidenced by the unusually higher rate of CHD compared with stroke among men and the low autopsy rate (1.9% of all deaths according to a report in 2013 35 ) in South Korea. Although the operational definition of CVD used in this study has been adopted from multiple previous studies using the same data source, 17,18 future studies that use a more accurate definition of CVD are needed to validate these findings.…”

Weight and Risk of Incident Atrial Fibrillation—Body Mass Index Variability or Body Mass Gain?

“…Recently, a longitudinal study of more than 2.5 million young adults in Korea found that overweight and obesity were associated with a higher risk of incident coronary heart disease and that weight gain in those with normal BMI at baseline also significantly increased this risk. 9 Finally, the limitation of BMI as a measure of risk of disease development has recently been highlighted in a study of 296,535 UK Biobank participants, in which other measures of adiposity, including waist circumference, waist to hip ratio, weight to height ratio, and percentage body fat mass, performed better in relation to incident cardiovascular disease risk instead of BMI, the latter often confounded by preexisting comorbidity. 10 This study contributes to our understanding of the risk of AF development in Asian populations.…”