Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: Pooled analysis of prospective data from the Asia Cohort Consortium

Yu Chen, Wade K. Copeland, Rajesh Vedanthan, Eric Grant, Jung Eun Lee, Dongfeng Gu, Prakash C. Gupta, Kunnambath Ramadas, Manami Inoue, Shoichiro Tsugane, Akiko Tamakoshi, Yu Tang Gao, Jian Min Yuan, Xiao Ou Shu, Kotaro Ozasa, Ichiro Tsuji, Masako Kakizaki, Hideo Tanaka, Yoshikazu Nishino, Chien Jen ChenRenwei Wang, Keun Young Yoo, Yoon Ok Ahn, Habibul Ahsan, Wen Harn Pan, Chung Shiuan Chen, Mangesh S. Pednekar, Catherine Sauvaget, Shizuka Sasazuki, Gong Yang, Woon Puay Koh, Yong Bing Xiang, Waka Ohishi, Takashi Watanabe, Yumi Sugawara, Keitaro Matsuo, San Lin You, Sue K. Park, Dong Hyun Kim, Faruque Parvez, Shao Yuan Chuang, Wenzhen Ge, Betsy Rolland, Dale McLerran, Rashmi Sinha, Mark Thornquist, Daehee Kang, Ziding Feng, Paolo Boffetta, Wei Zheng, Jiang He, John D. Potter

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Objective To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. Design Pooled analyses of 20 prospective cohorts in Asia, including data from 835 082 east Asians and 289 815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability. Setting General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh). Participants 1 124 897 men and women (mean age 53.4 years at baseline). Main outcome measures Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes. Results 49 184 cardiovascular deaths (40 791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12). Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.

Original languageEnglish
Article numberf5446
JournalBMJ (Online)
Volume347
Issue number7927
DOIs
Publication statusPublished - 05-10-2013

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Body Mass Index
Cardiovascular Diseases
Mortality
Stroke
Coronary Disease
Confidence Intervals
Reference Values
Republic of Korea
Bangladesh
Far East
Singapore
Taiwan
India
China
Japan
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Chen, Yu ; Copeland, Wade K. ; Vedanthan, Rajesh ; Grant, Eric ; Lee, Jung Eun ; Gu, Dongfeng ; Gupta, Prakash C. ; Ramadas, Kunnambath ; Inoue, Manami ; Tsugane, Shoichiro ; Tamakoshi, Akiko ; Gao, Yu Tang ; Yuan, Jian Min ; Shu, Xiao Ou ; Ozasa, Kotaro ; Tsuji, Ichiro ; Kakizaki, Masako ; Tanaka, Hideo ; Nishino, Yoshikazu ; Chen, Chien Jen ; Wang, Renwei ; Yoo, Keun Young ; Ahn, Yoon Ok ; Ahsan, Habibul ; Pan, Wen Harn ; Chen, Chung Shiuan ; Pednekar, Mangesh S. ; Sauvaget, Catherine ; Sasazuki, Shizuka ; Yang, Gong ; Koh, Woon Puay ; Xiang, Yong Bing ; Ohishi, Waka ; Watanabe, Takashi ; Sugawara, Yumi ; Matsuo, Keitaro ; You, San Lin ; Park, Sue K. ; Kim, Dong Hyun ; Parvez, Faruque ; Chuang, Shao Yuan ; Ge, Wenzhen ; Rolland, Betsy ; McLerran, Dale ; Sinha, Rashmi ; Thornquist, Mark ; Kang, Daehee ; Feng, Ziding ; Boffetta, Paolo ; Zheng, Wei ; He, Jiang ; Potter, John D. / Association between body mass index and cardiovascular disease mortality in east Asians and south Asians : Pooled analysis of prospective data from the Asia Cohort Consortium. In: BMJ (Online). 2013 ; Vol. 347, No. 7927.
@article{4ef16ec75d5c4f0fb9878ada1680b64f,
title = "Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: Pooled analysis of prospective data from the Asia Cohort Consortium",
abstract = "Objective To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. Design Pooled analyses of 20 prospective cohorts in Asia, including data from 835 082 east Asians and 289 815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability. Setting General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh). Participants 1 124 897 men and women (mean age 53.4 years at baseline). Main outcome measures Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes. Results 49 184 cardiovascular deaths (40 791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95{\%} confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95{\%} confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95{\%} confidence interval 1.15 to 3.12). Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.",
author = "Yu Chen and Copeland, {Wade K.} and Rajesh Vedanthan and Eric Grant and Lee, {Jung Eun} and Dongfeng Gu and Gupta, {Prakash C.} and Kunnambath Ramadas and Manami Inoue and Shoichiro Tsugane and Akiko Tamakoshi and Gao, {Yu Tang} and Yuan, {Jian Min} and Shu, {Xiao Ou} and Kotaro Ozasa and Ichiro Tsuji and Masako Kakizaki and Hideo Tanaka and Yoshikazu Nishino and Chen, {Chien Jen} and Renwei Wang and Yoo, {Keun Young} and Ahn, {Yoon Ok} and Habibul Ahsan and Pan, {Wen Harn} and Chen, {Chung Shiuan} and Pednekar, {Mangesh S.} and Catherine Sauvaget and Shizuka Sasazuki and Gong Yang and Koh, {Woon Puay} and Xiang, {Yong Bing} and Waka Ohishi and Takashi Watanabe and Yumi Sugawara and Keitaro Matsuo and You, {San Lin} and Park, {Sue K.} and Kim, {Dong Hyun} and Faruque Parvez and Chuang, {Shao Yuan} and Wenzhen Ge and Betsy Rolland and Dale McLerran and Rashmi Sinha and Mark Thornquist and Daehee Kang and Ziding Feng and Paolo Boffetta and Wei Zheng and Jiang He and Potter, {John D.}",
year = "2013",
month = "10",
day = "5",
doi = "10.1136/bmj.f5446",
language = "English",
volume = "347",
journal = "The BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",
number = "7927",

}

Chen, Y, Copeland, WK, Vedanthan, R, Grant, E, Lee, JE, Gu, D, Gupta, PC, Ramadas, K, Inoue, M, Tsugane, S, Tamakoshi, A, Gao, YT, Yuan, JM, Shu, XO, Ozasa, K, Tsuji, I, Kakizaki, M, Tanaka, H, Nishino, Y, Chen, CJ, Wang, R, Yoo, KY, Ahn, YO, Ahsan, H, Pan, WH, Chen, CS, Pednekar, MS, Sauvaget, C, Sasazuki, S, Yang, G, Koh, WP, Xiang, YB, Ohishi, W, Watanabe, T, Sugawara, Y, Matsuo, K, You, SL, Park, SK, Kim, DH, Parvez, F, Chuang, SY, Ge, W, Rolland, B, McLerran, D, Sinha, R, Thornquist, M, Kang, D, Feng, Z, Boffetta, P, Zheng, W, He, J & Potter, JD 2013, 'Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: Pooled analysis of prospective data from the Asia Cohort Consortium', BMJ (Online), vol. 347, no. 7927, f5446. https://doi.org/10.1136/bmj.f5446

Association between body mass index and cardiovascular disease mortality in east Asians and south Asians : Pooled analysis of prospective data from the Asia Cohort Consortium. / Chen, Yu; Copeland, Wade K.; Vedanthan, Rajesh; Grant, Eric; Lee, Jung Eun; Gu, Dongfeng; Gupta, Prakash C.; Ramadas, Kunnambath; Inoue, Manami; Tsugane, Shoichiro; Tamakoshi, Akiko; Gao, Yu Tang; Yuan, Jian Min; Shu, Xiao Ou; Ozasa, Kotaro; Tsuji, Ichiro; Kakizaki, Masako; Tanaka, Hideo; Nishino, Yoshikazu; Chen, Chien Jen; Wang, Renwei; Yoo, Keun Young; Ahn, Yoon Ok; Ahsan, Habibul; Pan, Wen Harn; Chen, Chung Shiuan; Pednekar, Mangesh S.; Sauvaget, Catherine; Sasazuki, Shizuka; Yang, Gong; Koh, Woon Puay; Xiang, Yong Bing; Ohishi, Waka; Watanabe, Takashi; Sugawara, Yumi; Matsuo, Keitaro; You, San Lin; Park, Sue K.; Kim, Dong Hyun; Parvez, Faruque; Chuang, Shao Yuan; Ge, Wenzhen; Rolland, Betsy; McLerran, Dale; Sinha, Rashmi; Thornquist, Mark; Kang, Daehee; Feng, Ziding; Boffetta, Paolo; Zheng, Wei; He, Jiang; Potter, John D.

In: BMJ (Online), Vol. 347, No. 7927, f5446, 05.10.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between body mass index and cardiovascular disease mortality in east Asians and south Asians

T2 - Pooled analysis of prospective data from the Asia Cohort Consortium

AU - Chen, Yu

AU - Copeland, Wade K.

AU - Vedanthan, Rajesh

AU - Grant, Eric

AU - Lee, Jung Eun

AU - Gu, Dongfeng

AU - Gupta, Prakash C.

AU - Ramadas, Kunnambath

AU - Inoue, Manami

AU - Tsugane, Shoichiro

AU - Tamakoshi, Akiko

AU - Gao, Yu Tang

AU - Yuan, Jian Min

AU - Shu, Xiao Ou

AU - Ozasa, Kotaro

AU - Tsuji, Ichiro

AU - Kakizaki, Masako

AU - Tanaka, Hideo

AU - Nishino, Yoshikazu

AU - Chen, Chien Jen

AU - Wang, Renwei

AU - Yoo, Keun Young

AU - Ahn, Yoon Ok

AU - Ahsan, Habibul

AU - Pan, Wen Harn

AU - Chen, Chung Shiuan

AU - Pednekar, Mangesh S.

AU - Sauvaget, Catherine

AU - Sasazuki, Shizuka

AU - Yang, Gong

AU - Koh, Woon Puay

AU - Xiang, Yong Bing

AU - Ohishi, Waka

AU - Watanabe, Takashi

AU - Sugawara, Yumi

AU - Matsuo, Keitaro

AU - You, San Lin

AU - Park, Sue K.

AU - Kim, Dong Hyun

AU - Parvez, Faruque

AU - Chuang, Shao Yuan

AU - Ge, Wenzhen

AU - Rolland, Betsy

AU - McLerran, Dale

AU - Sinha, Rashmi

AU - Thornquist, Mark

AU - Kang, Daehee

AU - Feng, Ziding

AU - Boffetta, Paolo

AU - Zheng, Wei

AU - He, Jiang

AU - Potter, John D.

PY - 2013/10/5

Y1 - 2013/10/5

N2 - Objective To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. Design Pooled analyses of 20 prospective cohorts in Asia, including data from 835 082 east Asians and 289 815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability. Setting General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh). Participants 1 124 897 men and women (mean age 53.4 years at baseline). Main outcome measures Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes. Results 49 184 cardiovascular deaths (40 791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12). Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.

AB - Objective To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. Design Pooled analyses of 20 prospective cohorts in Asia, including data from 835 082 east Asians and 289 815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability. Setting General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh). Participants 1 124 897 men and women (mean age 53.4 years at baseline). Main outcome measures Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes. Results 49 184 cardiovascular deaths (40 791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12). Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.

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