Severe obesity, heart disease, and death among white, african american, and hispanic postmenopausal women

Kathleen M. McTigue, Yue Fang Chang, Charles Eaton, Lorena Garcia, Karen C. Johnson, Cora E. Lewis, Simin Liu, Rachel H. Mackey, Jennifer Robinson, Milagros C. Rosal, Linda Snetselaar, Alice Valoski, Lewis H. Kuller

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Objective To compare mortality, nonfatal coronary heart disease (CHD), and congestive heart failure (CHF) risk across BMI categories in white, African American, and Hispanic women, with a focus on severe obesity (BMI ≥ 40), and examine heterogeneity in weight-related CHD risk. Methods Among 156,775 Women's Health Initiative observational study and clinical trial participants (September 1993-12 September 2005), multivariable Cox models estimated relative risk for mortality, CHD, and CHF. CHD incidence was calculated by anthropometry, race, and cardiovascular risk factors (CVRF). Results Mortality, nonfatal CHD, and CHF incidence generally rose with BMI category. For severe obesity versus normal BMI, hazard ratios (HRs, 95% confidence interval) for mortality were 1.97 (1.77-2.20) in white, 1.55 (1.20-2.00) in African American, and 2.59 (1.55-4.31) in Hispanic women; for CHD, HRs were 2.05 (1.80-2.35), 2.24 (1.57-3.19), and 2.95 (1.60-5.41) respectively; for CHF, HRs were 5.01 (4.33-5.80), 3.60 (2.30-5.62), and 6.05 (2.49-14.69). CVRF variation resulted in substantial variation in CHD rates across BMI categories, even in severe obesity. CHD incidence was similar by race/ethnicity when differences in BMI or CVRF were accounted for. Conclusions Severe obesity increases mortality, nonfatal CHD, and CHF risk in women of diverse race/ethnicity. CVRF heterogeneity contributes to variation in CHD incidence even in severe obesity.

Original languageEnglish (US)
Pages (from-to)801-810
Number of pages10
JournalObesity
Volume22
Issue number3
DOIs
StatePublished - 2014

Keywords

  • cardiovascular diseases/epidemiology
  • cardiovascular diseases/etiology
  • longitudinal studies
  • obesity, morbid/complications
  • obesity, morbid/epidemiology
  • obesity/epidemiology, obesity/complications

ASJC Scopus subject areas

  • Endocrinology
  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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    McTigue, K. M., Chang, Y. F., Eaton, C., Garcia, L., Johnson, K. C., Lewis, C. E., Liu, S., Mackey, R. H., Robinson, J., Rosal, M. C., Snetselaar, L., Valoski, A., & Kuller, L. H. (2014). Severe obesity, heart disease, and death among white, african american, and hispanic postmenopausal women. Obesity, 22(3), 801-810. https://doi.org/10.1002/oby.20224