Obesity and subtypes of incident cardiovascular disease
Open accessAbstract
BACKGROUND: Obesity is a risk factor for various subtypes of cardiovascular disease (CVD), including coronary heart disease (CHD), heart failure (HF), and stroke. Nevertheless, there are limited comparisons of the associations of obesity with each of these CVD subtypes, particularly regarding the extent to which they are unexplained by traditional CVD mediators. METHODS AND RESULTS: We followed 13 730 participants in the Atherosclerosis Risk in Communities (ARIC) study who had a body mass index ≥18.5 and no CVD at baseline (visit 1, 1987-1989). We compared the association of higher body mass index with incident HF, CHD, and stroke before and after adjusting for traditional CVD mediators (including systolic blood pressure, diabetes mellitus, and lipid measures). Over a median follow-up of 23 years, there were 2235 HF events, 1653 CHD events, and 986 strokes. After adjustment for demographics, smoking, physical activity, and alcohol intake, higher body mass index had the strongest association with incident HF among CVD subtypes, with hazard ratios for severe obesity (body mass index ≥35 versus normal weight) of 3.74 (95% CI 3.24-4.31) for HF, 2.00 (95% CI 1.67-2.40) for CHD, and 1.75 (95% CI 1.40-2.20) for stroke (P<0.0001 for comparisons of HF versus CHD or stroke). Further adjustment for traditional mediators fully explained the association of higher body mass index with CHD and stroke but not with HF (hazard ratio 2.27, 95% CI 1.94-2.64). CONCLUSIONS: The link between obesity and HF was stronger than those for other CVD subtypes and was uniquely unexplained by traditional risk factors. Weight management is likely critical for optimal HF prevention, and nontraditional pathways linking obesity to HF need to be elucidated.
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Obesity is a known independent risk factor for multiple cardiovascular diseases.
“Obesity is a known independent risk factor for multiple cardiovascular diseases [16,21,22]”
From PPG-Based Heart Rate Accuracy in Hispanic Adults with Fitzpatrick III–V Skin Tones: An Evaluation of Body Composition and Skin-Tone Effects (2026) · cites this paper as [16]
The Results report that obesity remained associated with incident heart failure after adjustment for traditional cardiovascular risk factors. They found no significant adjusted association with coronary heart disease or stroke. The claim’s description of obesity as an established independent risk factor for multiple cardiovascular diseases therefore overstates this paper’s findings. (LLM, conf=0.88)
Experimental — accuracy not yet measuredObesity alters dermal parameters including increased dermal thickness, greater trans-epidermal water loss, reduced capillary density, and increased depth of arteries such as the radial artery.
“Obesity alters several key dermal parameters: increased dermal thickness, greater trans-epidermal water loss (TEWL), reduced capillary density, and increased depth of arteries such as the radial artery.”
From PPG-Based Heart Rate Accuracy in Hispanic Adults with Fitzpatrick III–V Skin Tones: An Evaluation of Body Composition and Skin-Tone Effects (2026) · cites this paper as [16]
The Discussion addresses obesity-related cardiac remodeling and heart failure, not dermal changes. Searches for dermal thickness, trans-epidermal water loss, capillary density, and radial-artery depth found no passage in our copy addressing those claims. (LLM, conf=0.77)
Experimental — accuracy not yet measuredObesity creates variations in skin physiology, including skin barrier function, epidermal changes, dermal changes, and changes to vascular and capillary recruitment function.
“Recent studies have shown that obesity creates variations in skin physiology5,35–38. These changes include but are not limited to skin barrier function, epidermal changes, dermal changes, and changes to the vascular and capillary recruitment function.”
From Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI) (2021) · cites this paper as [5]
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- Authors
- Ndumele, C. E., Matsushita, K., Lazo, M., Bello, N., Blumenthal, R. S., Gerstenblith, G., Nambi, V., Ballantyne, C. M., Solomon, S. D., Selvin, E., Folsom, A. R., & Coresh, J.
- Affiliations
- Johns Hopkins University (US)
- Columbia University Irving Medical Center (US)
- Michael E. DeBakey VA Medical Center (US)
- Baylor College of Medicine (US)
- Brigham and Women's Hospital (US)
- University of Minnesota (US)
- Corresponding author
- Ndumele, Chiadi E.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2016-08-08
- Volume
- 5
- Issue
- 8
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC5015307
- OpenAlex
- W2480369291
- Cited by
- 259
- References
- 50
- Citations by year
- 2026: 32 · 2025: 40 · 2024: 36 · 2023: 31 · 2022: 25 · 2021: 25 · 2020: 14 · 2019: 22 · 2018: 14 · 2017: 20
- FWCI
- 15.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007C, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN268201100005C, HHSN268201100010C, K23HL122447, HHSN26820 1100009C, L30 HL129418)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK106414, R01DK089174)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity, body mass index, heart failure, coronary artery disease, stroke, incident cardiovascular disease, traditional cardiovascular risk factors, mediation analysis, weight management, Atherosclerosis Risk in Communities Study
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Coronary Disease, Female, Heart Failure, Humans, Male, Middle Aged, Obesity, Morbid, Risk Factors, United States, Body Mass Index, Stroke, Atherosclerosis, Sedentary Behavior, Memory, Episodic
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