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Causal Associations of Adiposity and Body Fat Distribution With Coronary Heart Disease, Stroke Subtypes, and Type 2 Diabetes MellitusClinical Perspective

Dale, Caroline E and Fatemifar, Ghazaleh and Palmer, Tom M and White, Jon and Prieto-Merino, David and Zabaneh, Delilah and Engmann, Jorgen EL and Shah, Tina and Wong, Andrew and Warren, Helen R and McLachlan, Stela and Trompet, Stella and Moldovan, Max and Morris, Richard W and Sofat, Reecha and Kumari, Meena and Hyppönen, Elina and Jefferis, Barbara J and Gaunt, Tom R and Ben-Shlomo, Yoav and Zhou, Ang and Gentry-Maharaj, Aleksandra and Ryan, Andy and Mutsert, Renée de and Noordam, Raymond and Caulfield, Mark J and Jukema, J Wouter and Worrall, Bradford B and Munroe, Patricia B and Menon, Usha and Power, Chris and Kuh, Diana and Lawlor, Debbie A and Humphries, Steve E and Mook-Kanamori, Dennis O and Sattar, Naveed and Kivimaki, Mika and Price, Jacqueline F and Davey Smith, George and Dudbridge, Frank and Hingorani, Aroon D and Holmes, Michael V and Casas, Juan P (2017) 'Causal Associations of Adiposity and Body Fat Distribution With Coronary Heart Disease, Stroke Subtypes, and Type 2 Diabetes MellitusClinical Perspective.' Circulation, 135 (24). 2373 - 2388. ISSN 0009-7322

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Abstract

Background—Implications of different adiposity measures on cardiovascular disease aetiology remain unclear. In this paper we quantify and contrast causal associations of central adiposity (waist:hip ratio adjusted for BMI (WHRadjBMI)) and general adiposity (body mass index (BMI)) with cardiometabolic disease. Methods—97 independent single nucleotide polymorphisms (SNPs) for BMI and 49 SNPs for WHRadjBMI were used to conduct Mendelian randomization analyses in 14 prospective studies supplemented with CHD data from CARDIoGRAMplusC4D (combined total 66,842 cases), stroke from METASTROKE (12,389 ischaemic stroke cases), type 2 diabetes (T2D) from DIAGRAM (34,840 cases), and lipids from GLGC (213,500 participants) consortia. Primary outcomes were CHD, T2D, and major stroke subtypes; secondary analyses included 18 cardiometabolic traits. Results—Each one standard deviation (SD) higher WHRadjBMI (1SD~0.08 units) associated with a 48% excess risk of CHD (odds ratio [OR] for CHD: 1.48; 95%CI: 1.28-1.71), similar to findings for BMI (1SD~4.6kg/m2; OR for CHD: 1.36; 95%CI: 1.22-1.52). Only WHRadjBMI increased risk of ischaemic stroke (OR 1.32; 95%CI 1.03-1.70). For T2D, both measures had large effects: OR 1.82 (95%CI 1.38-2.42) and OR 1.98 (95%CI 1.41-2.78) per 1SD higher WHRadjBMI and BMI respectively. Both WHRadjBMI and BMI were associated with higher left ventricular hypertrophy, glycaemic traits, interleukin-6, and circulating lipids. WHRadjBMI was also associated with higher carotid intima-media thickness (39%; 95%CI: 9%-77% per 1SD). Conclusions—Both general and central adiposity have causal effects on CHD and T2D. Central adiposity may have a stronger effect on stroke risk. Future estimates of the burden of adiposity on health should include measures of central and general adiposity.

Item Type: Article
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > R Medicine (General)
Divisions: Faculty of Social Sciences > Institute for Social and Economic Research
Depositing User: Jim Jamieson
Date Deposited: 21 Jul 2017 10:54
Last Modified: 04 Sep 2018 11:15
URI: http://repository.essex.ac.uk/id/eprint/20087

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