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BMI in Adolescence & CV Death in Adulthood

N Engl J Med; ePub 2016 Apr 13; Twig, Yaniv, et al

Publish date:

Being overweight or obese in adolescence is strongly associated with increased cardiovascular mortality in adulthood, according to a study that examined the association between body mass index (BMI) in late adolescence and death from CV causes in adulthood. Researchers found:

• During 42,297,007 person-years follow-up (40 years of follow-up), 2,918 of 32,127 deaths (9.1%) were from CV causes, including 1,497 from coronary heart disease, 528 from stroke, and 893 from sudden death.

• There was a graded increase in the risk of death from CV causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (within the accepted normal range).

• Hazard ratios (HRs) in the obese group (≥95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 for death from coronary heart disease, 2.6 for death from stroke, 2.1 for sudden death, and 3.5 for death from total CV causes.

• HRs for death from CV causes in the same percentile groups increased from 2.0 during follow-up for 0 to 10 years to 4.1 during follow-up for 30 to 40 years.

Citation: Twig G, Yaniv G, Levine H et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. [Published online ahead of print April 13, 2016]. N Engl J Med. doi:10.1056/NEJMoa1503840.

Commentary: This study has important implications for the future health of this country. The 40 years of follow up here, given the entry age to the study of 17, only shows CV death through middle age. Middle age is the time when CV disease really just begins to increase in prevalence, so we would expect the association described to only become worse over time. Given the increase in obesity among youth over the last 25 years, this study suggests that we are likely to see a substantial increase in the development of CV disease moving into the future, perhaps eroding many of the advances in treatment that have led to decreases in CV disease mortality over the last 20 years. Critical for those of us in primary care to understand though, is that being overweight in adolescence is not destiny. Good studies have shown that beginning to exercise and diet in middle age leads to decreased CV risk factors and mortality moving forward.1,2 Good habits should start early, and we should counsel all our patients, from children to adults, on the importance of a healthy diet and exercise. —Neil Skolnik, MD

1. Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012;59(7):665-72. doi:10.1016/j.jacc.2011.11.013.

2. Blair SN, Kohl HW 3rd, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273(14):1093-1098.

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