Impaired Fasting Glucose and Body Mass Index as Determinants of Mortality in ALLHAT: Is the Obesity Paradox Real?
Open accessAbstract
Emerging literature suggests that obesity may be “protective” against mortality and cardiovascular outcomes, while dysglycemia may worsen outcomes regardless of obesity. The authors measured the association of weight, smoking, and glycemia with mortality in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Among 5423 ALLHAT participants without established diabetes or cardiovascular disease, 3980 (73%) had normal fasting glucose and 1443 (27%) had impaired fasting glucose (IFG) levels at study entry. After a median of 4.9 years follow‐up, 554 (10%) had died (37% cardiovascular). IFG was associated with higher all‐cause mortality (adjusted hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.02–1.50), while obesity was associated with lower all‐cause mortality (adjusted HR, 0.76; 95% CI, 0.60–0.96). However, after excluding underweight individuals (body mass index [BMI] <22 kg/m 2) and smokers, neither obesity nor IFG was associated with all‐cause mortality, but IFG identifies individuals at greater risk in the nonobese population. Although obesity appeared protective against mortality, this association was not significant in never‐smokers or after exclusion of BMI <22 kg/m 2. The obesity paradox may result from confounding by a sicker, underweight referent population and smoking.
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In a post hoc analysis of ALLHAT, after removal of those with BMI <22 kg/m2 and never-smokers, the protective effect of obesity was removed.
“In a post hoc analysis, after removal of those with BMI <22 kg/m 2 and never-smokers, the protective effect of obesity was removed.”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [15]
In an ALLHAT cohort of hypertensive patients without diabetes mellitus or manifest cardiovascular disease at entry, obesity was associated with lower all-cause mortality.
“In an ALLHAT study (The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) cohort of hypertensive patients without diabetes mellitus or manifest cardiovascular disease at entry, obesity was also found to be associated with lower all-cause mortality.15”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [15]
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References 36 · Cited by 21
Research works printed but not linked: 1
- [23]Yeboah J Bertoni AG Herrington DM Post WS Burke GL Impaired fasting glucose and the risk of incident diabetes mellitus and cardiovascular events in an adult population: MESA (Multi-Ethnic Study of Atherosclerosis) J Am Coll Cardiol 2011 58 140 146 21718910 PMC3146297
- Authors
- Shah, R. V., Abbasi, S. A., Yamal, J., Davis, B. R., Barzilay, J., Einhorn, P. T., Goldfine, A., & the ALLHAT Collaborative Research Group
- Affiliations
- Massachusetts General Hospital (US)
- Brigham and Women's Hospital (US)
- Division of Biostatistics The University of Texas School of Public Health Houston TX
- Kaiser Permanente (US)
- National Heart, Lung, and Blood Institute (US)
- Joslin Diabetes Center (US)
- Corresponding author
- Yamal, José‐Miguel
- ORCID
- Venue
- The Journal of Clinical Hypertension
- Publisher
- Wiley
- Published
- 2014-04-29
- Volume
- 16
- Issue
- 6
- Pages
- 451-458
- ISSN
- 1524-6175 (ISSN-L)
- 1751-7176
- PMC
- PMC4091725
- OpenAlex
- W2016195011
- Cited by
- 21
- References
- 36
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 2
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Hypertension (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (NO1-HC-35130, HHSN268201100036C)
- American Heart Association Post-Doctoral Research Award
- Pfizer, Inc.
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity paradox, impaired fasting glucose, body mass index, all-cause mortality, cardiovascular mortality, smoking, underweight, confounding, dysglycemia, ALLHAT trial
- MeSH terms
- Aged, Antihypertensive Agents, Blood Glucose, Cause of Death, Double-Blind Method, Fasting, Female, Humans, Hypertension, Male, Middle Aged, Obesity, Prognosis, United States, Body Mass Index, Survival Rate
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