The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis

Abstract

BackgroundThe effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available.MethodsWe reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models.ResultsAcross all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55–64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09–2.24), followed by effects on both stroke subtypes (1.66; 1.39–1.98 for hemorrhagic stroke and 1.63; 1.57–1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29–1.61) for IHD and 1.20 (1.15–1.25) for ischemic stroke. The RRs for 5 kg/m2 higher BMI for ages 55–64 ranged from 2.32 (2.04–2.63) for diabetes, to 1.44 (1.40–1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08–1.29) for IHD and 1.14 (1.01–1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs.ConclusionOur results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.

Body Mass Index and Vascular Disease in Men Aged 65 Years and Over: HIMS (Health In Men Study)

“…These are consistent with the present study for ischemic heart disease and ischemic stroke (there were too few intracerebral hemorrhage events in the present study for statistical stability). Another large meta‐analysis of cohort studies from mainly the Asia‐Pacific region described associations at ages 75 to 84 years that were also consistent with the present study for ischemic heart disease and ischemic stroke, but, unlike the Prospective Studies Collaboration, there was not strong evidence of an association between BMI and intracerebral hemorrhage 1, 3. The association at ages 75 to 84 years in these meta‐analyses are slightly shallower than those reported in these same meta‐analyses at younger ages.…”

“…The Prospective Studies Collaboration meta‐analysis also reported the strength of the age‐specific associations in the higher BMI range for ischemic heart disease and subtypes of stroke 1. At ages 75 to 84 years, 5 kg/m 2 higher BMI was associated with 31% (95% CI, 23–39) higher risk of ischemic heart disease, 23% (16–31) higher risk of ischemic stroke, and 32% (22–44) higher risk of intracerebral hemorrhage.…”

“…Body mass index (BMI) is a commonly used measure of general adiposity and an established risk factor for vascular disease 1, 2, 3. Despite this, the association between BMI and incidence of major vascular events in older adults has not been well described.…”

Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi‐centre intervention study after a low‐energy diet in 2500 overweight, individuals with pre‐diabetes (PREVIEW)

“…The greater reduction in intra‐abdominal fat in men is accompanied by a more pronounced improvement in metabolic risk profile. Therefore, greater improvement in terms of risk factors in men is not only related to a greater negative energy balance, but also to a gender‐specific effect 16, 17…”

Weight Management for Athletes: Important Things to be Considered

“…Individuals with body mass index (BMI) falling within 25-29.9kg/m 2 are indicated as overweight, whereas individuals with BMI at or above 30kg/m 2 are indicated as obese [41]. Based on a study conducted in 2014, revealed that within four decades the global obesity in men has tripled, from 3.2% in 1975 to 10.8% in 2014 [43]. During the same period, obesity in women has more than doubled from 6.4% in 1975 to 14.9% in 2014.…”