Interaction of Body Mass Index and Framingham Risk Score in Predicting Incident Coronary Disease in Families

Abstract

Background-Siblings of individuals with premature coronary heart disease (CHD) have a marked excess risk of CHD risk factors and premature CHD. The impact of body mass index (BMI) on incident CHD in these families and the extent to which it may be mediated by associated risk factors are unknown. The aim of this study was to examine the effect of high BMI on incident CHD in white and black families with premature CHD and to estimate the heritability of BMI. Methods and Results-Risk factors, BMI, and Framingham Risk Score (FRS) were assessed at baseline and incident CHD was determined prospectively in 827 apparently healthy siblings of probands with premature CHD aged Ͻ60 years. During a mean follow-up of 8.7 years, 13.3% of siblings had incident CHD events. Event rates were higher in obese and overweight siblings than in those with normal weight (15.3% and 16.0% versus 8.1%, respectively; Pϭ0.01).Multivariable Cox proportional hazards analyses demonstrated the independent prognostic value of BMI when added to FRS (Pϭ0.02). A marked interaction between obesity (BMI Ն30 kg/m 2 ) and high FRS (Ͼ20%) was seen for incident CHD (P for interactionϭ0.008), with an adjusted hazard ratio compared with low-FRS/normal-weight siblings of 14.63 (95% CI, 6.40 to 33.44; PϽ0.0001). BMI heritability (h 2 ) was moderate for whites and low for blacks (52% and 29%, respectively). Conclusions-High

Impact of Abnormal Glucose Tolerance, Hypertension and Other Risk Factors on Coronary Artery Disease

“…It has been reported that obesity is involved in the onset of CAD 27,28 and in the present study BMI was found to be significantly higher in the recurrence group, which is consistent with the recently proposed concept of metabolic syndrome in which abdominal obesity is an important risk factor for cardiovascular disease.…”

Effect of school-based physical activity interventions on body mass index in children: a meta-analysis

“…In adults, an elevated BMI is associated with increased rates of diabetes mellitus, heart disease, cancer and death. [60][61][62] Similarly, elevated BMI in children is associated with increased blood pressure, hyperlipidemia and type 2 diabetes, as well as development of coronary artery disease and increased all-cause mortality later in life. 1,[63][64][65][66] Children with elevated BMI are at high risk of having elevated BMI as adults.…”

Young Adults With Family History of Coronary Heart Disease Have Increased Arterial Vulnerability to Metabolic Risk Factors

“…Similarly, a recent study by Michos et al 4 demonstrated that a familial propensity to subclinical atherosclerosis interacts with metabolic risk factors, magnifying the risk of individuals exposed multiple risk factors. In addition, a family study by Mora et al 5 suggested that obesity may substantially increase the risk of CHD for siblings of probands with premature CHD. These observations suggest that the additional risk associated with family history may in part be attributable to increased arterial vulnerability to the proatherogenic effects of metabolic risk factors.…”

“…Michos et al 4 observed that subjects with a family history of CHD had higher prevalence of coronary artery calcium in the presence of metabolic risk factors than those without family history. Mora et al 5 reported that obesity substantially increased the risk of CHD for siblings of subjects with premature CHD, especially for those with clustering of risk markers.…”