Changes in Burden of Cardiovascular Disease Following Hypothetical Reductions in Adiposity

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  • March 20, 2019
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  • Gellert, Shannon
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Cardiovascular diseases (CVD) such as peripheral artery disease (PAD) and coronary heart disease (CHD) are prominent causes of disability and death. PAD is a limb and life-threatening condition affecting 8.5 million U.S adults and CHD is the leading cause of death in the U.S. Risk factors for these CVD include hypertension and diabetes, which may lie on the causal pathway from adiposity to PAD and CHD. Therefore, adiposity may represent a modifiable upstream risk factor for PAD and CHD. Given the temporal increase in adiposity in the U.S. and the need to address the adverse health effects of adiposity at the population level, this doctoral research aimed to estimate the impact of hypothetical population reductions in adiposity on the incidence of PAD and CHD. Our study population included over 13,000 Atherosclerosis Risk in Communities participants examined from 1987 to 2001 at 4 triennial study visits during which exposure and covariate information were ascertained. Incident PAD and CHD events were identified from cohort follow-up and active health event surveillance. The parametric g-formula was used to estimate the risk difference of PAD and CHD following a hypothetical 5% reduction in body mass index (BMI) or waist circumference (WC) relative to the natural course of the BMI or WC trajectory, to a minimum BMI of 24 kg/m2 or WC of 88 cm. Participants with incident PAD or CHD were older at baseline, and more likely to be male, of white race, have less than a high school education, smoke, have diabetes, and have hypertension compared to those without incident PAD or CHD. We estimated a small risk difference for PAD [-0.17%, 95% confidence interval (CI): -0.38, 0.13%] following a 5% reduction in BMI. The estimated risk difference for CHD was -0.56% (95% CI: -0.96, -0.14%) following a 5% reduction in BMI, and -0.96% (95% CI: -1.44, 0.48%) following a 5% reduction in WC. If replicated in other populations these results can inform prevention-oriented research into the health effects of dynamic population distributions of adiposity measures.
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  • In Copyright
Advisor
  • Zeng, Donglin
  • Heiss, Gerardo
  • Siega-Riz, Anna Maria
  • Aubert, Ronald
  • Avery, Christy
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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