Obesity confers similar 30-year risk of cardiovascular disease or diabetes as hypertension or hypercholesterolemia in young adults

Abstract

Introduction: Prevention of atherosclerosis should be started in children or young adults. Thus, we need adequate predictive tools to target high-risk individuals of developing CVD or diabetes for preventive activities. Obesity in people aged >40 y.o. was shown to be independent but less strong CVD risk factor than arterial hypertension (AH) or hypercholesterolemia. Purpose: To assess the prevalence of preobese or obese young adults with normal versus abnormal cardiometabolic profile and to compare their absolute risk of developing CVD or diabetes with non-obese subjects. Methods: A sample of 2552 (1201 men and 1351 women) Framingham participants free of cardiovascular disease (CVD) and diabetes, aged 25-39 (mean 31.6) were followed for 30 years for the development of cardiovascular disease, diabetes or death. Four groups were defined based on baseline levels of risk factors: 1. BMI <27.5 and no hypertension (blood pressure <140/90 mmHg) nor dyslipidemia (LDL Cholesterol <130 mg/dl and HDL-Ch ≥40 mg/dl in men, ≥50 mg/dl in women and Triglicerides <150 mg/dl), 2. BMI <27.5 and hypertension or dyslipidemia, 3. BMI ≥27.5 and no hypertension nor dyslipidemia, 4. BMI ≥27.5 and hypertension or dyslipidemia. Results: In our sample about 20% of young adults with BMI ≥27,5 kg/m2 were free of hypertension and dyslipidemia. However, the absolute 30-year risk of developing CVD or diabetes was in this group equal to 23% and was almost the same as in individuals with BMI <27,5 kg/m2 but with hypertension or dyslipidemia. In contrast, the absolute risk in subjects with BMI <27,5 kg/m2 free of hypertension or dyslipidemia was only 13% and in individuals with BMI ≥ 27.5 and hypertension or dyslipidemia - 45%. These results were confirmed when BMI ≥27.5, hypertension and dyslipidemia were included in a multivariable model predicting 30-year risk of the combined endpoint adjusting for age, sex and smoking status. The hazard ratios were 1.63 (95% CI 1.54, 2.19) for BMI ≥27.5, 1.80 (95% CI 1.45, 2.22) for hypertension and 1.78 (95% CI 1.47, 2.15) for dyslipidemia. Conclusions: Our results indicate that obesity greatly increases the risk of cardiovascular disease or diabetes in young adults and its impact is similar in magnitude to that of hypertension and dyslipidemia. These findings suggest that prevention of obesity should start before the young adulthood and that aggressive lifestyle intervention is necessary regardless of the level of other risk factors.