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Adiposity throughout adulthood and risk of sudden cardiac death in women.

ABSTRACT: Sudden cardiac death (SCD) is often the first manifestation of coronary heart disease (CHD) among women. Data regarding BMI and risk of SCD are limited and conflicting.We examined the association of BMI repeatedly measured over 32 years and BMI during early and mid-adulthood with risk of SCD in the Nurses' Health Study.We prospectively followed 72,484 women free of chronic disease from 1980-2012. We ascertained adult height, current weight, and weight at age 18 at baseline and updated weight biennially. The primary endpoint was SCD (n=445).When updated biennially, higher BMI was associated with greater SCD risk after adjusting for confounders (p, linear trend: <0.001). Compared to a BMI of 21.0-22.9, the multivariate RR (95%CI) of SCD was 1.46 (1.05, 2.04) for BMI 25.0-29.9, 1.46 (1.00, 2.13) for BMI 30.0-34.9 and 2.18 (1.44, 3.28) for BMI ?35.0. Among women with a BMI ?35.0, SCD remained elevated even after adjustment for interim development of CHD and other mediators (RR: 1.72; 95%CI: 1.13, 2.60). In contrast, the association between BMI and fatal CHD risk was completely attenuated after adjustment for mediators. The magnitude of the association between BMI and SCD was greater when BMI was assessed at baseline or at age 18, at which time SCD risk remained significantly elevated at BMI?30 after adjustment for mediators.Higher BMI was associated with greater risk of SCD, particularly when assessed earlier in adulthood. Strategies to maintain a healthy weight throughout adulthood may minimize SCD incidence.

SUBMITTER: Chiuve SE

PROVIDER: S-EPMC4725590 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Adiposity throughout adulthood and risk of sudden cardiac death in women.

Chiuve Stephanie E SE Sun Qi Q Sandhu Roopinder K RK Tedrow Usha U Cook Nancy R NR Manson JoAnn E JE Albert Christine M CM

JACC. Clinical electrophysiology 20151201 6

<h4>Background</h4>Sudden cardiac death (SCD) is often the first manifestation of coronary heart disease (CHD) among women. Data regarding BMI and risk of SCD are limited and conflicting.<h4>Objectives</h4>We examined the association of BMI repeatedly measured over 32 years and BMI during early and mid-adulthood with risk of SCD in the Nurses' Health Study.<h4>Methods</h4>We prospectively followed 72,484 women free of chronic disease from 1980-2012. We ascertained adult height, current weight, a ...[more]

PMID: 26824079

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Project description:BACKGROUND:Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death. METHODS:The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants. RESULTS:During 10 years' follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P = .82; black-specific chi-squared 4.1, P = .77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99). CONCLUSIONS:The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.

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Adiposity throughout adulthood and risk of sudden cardiac death in women.

Publications

Adiposity throughout adulthood and risk of sudden cardiac death in women.

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