HealthDay News — The J-shaped correlation seen for body mass index (BMI) with cardiovascular disease (CVD) risk is susceptible to confounding due to pre-existing comorbidities, according to a study published online in the European Heart Journal.

Stamatina Iliodromiti, MD, from the University of Glasgow in the United Kingdom, and colleagues examined the correlations between body composition with incident CVD outcomes in a cohort of 296,535 healthy individuals of white European descent without CVD at baseline. Five different measures of adiposity were included as exposures.

The researchers found that low BMI correlated with higher incidence of CVD; the lowest CVD risk was seen at BMI of 22 to 23 kg/m², with an increase in CVD risk with higher BMI. In subgroup analyses excluding participants with comorbidities, the J-shaped correlation was attenuated substantially. More linear correlations were seen for the other adiposity measures: a one standard deviation increase in waist circumference correlated with a hazard ratio of 1.16 and 1.10 for women and men, respectively, with associations of similar magnitude for waist-to-hip ratio, waist-to-height ratio, and percentage body fat mass.

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“Increasing adiposity has a detrimental association with CVD health in middle-aged men and women. The association of BMI with CVD appears more susceptible to confounding due to pre-existing comorbidities when compared with other adiposity measures,” the authors wrote. “Any public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.”


Iliodromiti S, Celis-Morales CA, Lyall DM, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296,535 adults of white European descent [published online March 16, 2018]. Eur Heart J. doi:10.1093/eurheartj/ehy057