Effect modification of general and central obesity by sex and age on cardiovascular outcomes: Targeted maximum likelihood estimation in the atherosclerosis risk in communities study.

Pubmed ID: 33662834

Journal: Diabetes & metabolic syndrome

Publication Date: March 1, 2021

Affiliation: Prevention of Cardiovascular Disease Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: saeedh_1999@yahoo.com.

MeSH Terms: Humans, Male, Female, Aged, Cardiovascular Diseases, Risk Factors, Cohort Studies, Age Factors, Middle Aged, Body Mass Index, Sex Factors, Prospective Studies, Follow-Up Studies, Obesity, Atherosclerosis, Obesity, Abdominal, Community Health Services, Likelihood Functions

Authors: Mansournia MA, Mozafar Saadati H, Mehrabi Y, Sabour S, Hashemi Nazari SS

Cite As: Mozafar Saadati H, Sabour S, Mansournia MA, Mehrabi Y, Hashemi Nazari SS. Effect modification of general and central obesity by sex and age on cardiovascular outcomes: Targeted maximum likelihood estimation in the atherosclerosis risk in communities study. Diabetes Metab Syndr 2021 Mar-Apr;15(2):479-485. Epub 2021 Feb 21.

Studies:

Abstract

BACKGROUND AND AIMS: To elucidate the effect modification of general and central obesity by sex and age on the risk of cardiovascular events. METHODS: The analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities study. Obesity was defined with body mass index (BMI), waist-to-hip ratio (WHR) and body shape index (BSI) which categorized the participants as obese and non-obese. Targeted maximum likelihood estimation was used to estimate the risk ratio (RR) with the tmle package in R software. RESULTS: After adjustment, the strongest effect of BMI on CHD was in females (RR (95%CI): 1.26 (1.11, 1.42)) and in age>54 (RR (95%CI): 1.16 (1.06, 1.27)) and for HF it was in age>54 (RR (95%CI): 1.18 (1.10, 1.26)) and in females (RR (95%CI): 1.17 (1.08, 1.28)). Regarding central obesity, WHR (RR (95%CI): 1.19 (1.05, 1.34)) had the strongest effects on CHD for males and BSI (RR (95%CI): 1.140 (1.02, 1.26)) for age ≤ 54, and for HF the WHR (RR (95%CI): 1.22 (1.10, 1.36)) and BSI (RR (95%CI): 1.18 (1.07, 1.30)) had the strongest effects for age≤54, respectively. CONCLUSION: Among males and age≤54, WHR index was associated with a higher risk of CHD and HF while BMI was so for females and age>54.