Author + information
- William J. Kostisa,b,
- Yujun Pana,b,
- Javier Cabreraa,b,
- John B. Kostisa,b,
- Abel E. Moreyraa,b,
- Sara L. Pressela,b and
- Barry R. Davisa,b
Background: Two types of relationships between risk factors and cardiovascular outcomes have been described: linear, as is the case with smoking where even one cigarette is worse than total abstinence, and U- or J-shaped as is the case for body mass index (BMI). Using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), we studied the relationship between BMI and all-cause mortality.
Methods: In the randomized, double-blind, practice-based ALLHAT, 32,819 hypertensive participants, aged at least 55 years, were followed for 8 years for all-cause mortality. We examined the relationship between BMI at baseline to all-cause mortality in unadjusted and adjusted analyses. This relationship was also studied using linear, quadratic, and cubic spline models. Patients randomized to doxazosin and those with missing values were excluded.
Results: A U-shaped relationship was observed for all-cause mortality, with increased risk among those with higher BMI and the highest risk among those with very low BMI (Figure). In analyses adjusted for age, female gender, comorbidities and risk factors for CV disease, the U-shaped mortality versus BMI curves were markedly attenuated, suggesting that these factors may mediate this relationship.
Conclusions: The lowest mortality in ALLHAT by BMI was within the obese range and the U-shaped relationship between BMI and mortality may be mediated by other risk factors.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 12:45 p.m.-12:55 p.m.
Session Title: New Insights Into Prediction and Treatment of Hypertension
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1314M-05
- 2017 American College of Cardiology Foundation