TY - JOUR
T1 - Cardiovascular risk stratification among individuals with obesity
T2 - The Coronary Artery Calcium Consortium
AU - Boakye, Ellen
AU - Grandhi, Gowtham R.
AU - Dardari, Zeina
AU - Adhikari, Rishav
AU - Soroosh, Garshasb
AU - Jha, Kunal
AU - Dzaye, Omar
AU - Tasdighi, Erfan
AU - Erhabor, John
AU - Kumar, Sant J.
AU - Whelton, Seamus
AU - Blumenthal, Roger S.
AU - Albert, Michael
AU - Rozanski, Alan
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Nasir, Khurram
AU - Rumberger, John A.
AU - Shaw, Leslee J.
AU - Blaha, Michael
N1 - Funding Information:
Dr. Blaha received support from National Institutes of Health award L30 HL110027 for the overall CAC Consortium.
Publisher Copyright:
© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.
PY - 2023/9
Y1 - 2023/9
N2 - Objective: The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. Methods: Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. Results: Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1–99, 100–299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49–2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81–6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02–14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2, CAC ≥ 300 remained significantly associated with the highest risk. Conclusions: Among individuals with obesity, including moderate–severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
AB - Objective: The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. Methods: Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. Results: Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1–99, 100–299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49–2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81–6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02–14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2, CAC ≥ 300 remained significantly associated with the highest risk. Conclusions: Among individuals with obesity, including moderate–severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
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U2 - 10.1002/oby.23832
DO - 10.1002/oby.23832
M3 - Article
C2 - 37534563
AN - SCOPUS:85166656598
SN - 1930-7381
VL - 31
SP - 2240
EP - 2248
JO - Obesity
JF - Obesity
IS - 9
ER -