Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium
Creators: name: Chen, Yu
name: Copeland, Wade K.
name: Vedanthan, Rajesh
name: Grant, Eric
name: Lee, Jung Eun
name: Gu, Dongfeng
name: Gupta, Prakash C.
name: Ramadas, Kunnambath
name: Inoue, Manami
name: Gao, Yu-Tang
name: Yuan, Jian-Min
name: Shu, Xiao-Ou
name: Ozasa, Kotaro
name: Tsuji, Ichiro
name: Kakizaki, Masako
name: Tanaka, Hideo
name: Nishino, Yoshikazu
name: Chen, Chien-Jen
name: Wang, Renwei
name: Yoo, Keun-Young
name: Ahn, Yoon-Ok
name: Ahsan, Habibul
name: Pan, Wen-Harn
name: Pednekar, Mangesh S.
name: Sauvaget, Catherine
name: Sasazuki, Shizuka
name: Yang, Gong
name: Koh, Woon-Puay
name: Xiang, Yong-Bing
name: Ohishi, Waka
name: Wantanabe, Takashi
name: Sugawara, Yumi
name: Matsuo, Keitaro
name: You, San-Lin
name: Park, Sue K.
name: Kim, Dong-Hyun
name: Parvez, Muhammad F.
name: Chuang, Shao-Yuan
name: Ge, Wenzhen
name: Rolland, Betsy
name: McLerran, Dale
name: Sinha, Rashmi
name: Thornquist, Mark
name: Kang, Daehee
name: Feng, Ziding
name: Boffetta, Paolo
name: Zhang, Wei
name: He, Jiang
name: Potter, John D.
Publisher: name: Columbia University
Year: 2013
Subjects: Public health
Epidemiology

description: Objective: To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians.
Design: Pooled analyses of 20 prospective cohorts in Asia, including data from 835 082 east Asians and 289 815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability.
Setting: General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh).
Participants: 1 124 897 men and women (mean age 53.4 years at baseline).
Main outcome measures: Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes.
Results: 49 184 cardiovascular deaths (40 791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and less than 15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12).
Conclusions: Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.