Incomplete Issue

10-year risk of cardiovascular disease and body mass index in association with the obesity paradox

Nima Motamed, Hossein Ajdarkosh, Majid Darkahian, Farhad Zamani, Behnam Rabiee, Amir Hossein Faraji, Mehdi Nikkhah, Mahmood Reza Khoonsari, Mansooreh Maadi, Fahimeh Safarnezhad Tameshkel, Hossein Keyvani, Mohammad Hadi Karbalaie Niya, Behzad Farahani



BACKGROUND: Some recent studies reported an inverse association between obesity and risk of cardiovascular diseases (CVD), heart failure related mortality rate, outcomes of myocardial infarction (MI), and the consequences of cardiovascular events interventions; this inverse association was named the obesity paradox. The present study was conducted with the aim to determine whether the obesity paradox will be detectable when the 10-year risk of CVD is estimated using CVD risk assessment tools.

METHODS: The related data of 2910 subjects aged 40-74 years obtained in our cohort study that was carried out among 6140 subjects in Amol, in northern Iran, was included in this study. CVD risk assessment tools were used to estimate the 10-year risk of CVD. Obesity was evaluated using
4 indices, including waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and body mass index (BMI). The receiver operating characteristic (ROC) curve analysis was utilized to evaluate the discriminatory power of obesity indices for 10-year risk of CVD.

RESULTS: Categorizing the participants to with and without obesity according to BMI showed that a significantly higher proportion of men with obesity had a 10-year risk of CVD ≥ 7.5% and ≥ 10% according to ACC/AHA and the Framingham approaches, respectively. A higher proportion of women without obesity had a 10-year risk of CVD ≥ 7.5% than women with obesity based on the ACC/AHA equation (28.54% vs. 24.15%; P = 0.0707). BMI had a non-significant AUC (< 0.5) according to the the ACC/AHA equation.

CONCLUSION: BMI showed a weak and non-significant inverse association with 10-year risk of CVD estimated using pooled cohort equations of ACC/AHA in women. However, this result cannot directly provide enough evidence for the obesity paradox.


Obesity; Cardiovascular Diseases; Risk Assessment; Body Mass Index

Full Text:

Remote PDF


Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945): 766-81.

Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307(5): 491-7.

Eckel RH, Krauss RM. American Heart Association call to action: Obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation 1998; 97(21): 2099-100.

Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377(9765): 557-67.

Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. JAMA 2013; 309(1): 71-82.

Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol 2014; 63(14): 1345-54.

McAuley P, Myers J, Abella J, Froelicher V. Body mass, fitness and survival in veteran patients: another obesity paradox? Am J Med 2007; 120(6): 518-24.

D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation 2008; 117(6): 743-53.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63(25 Pt B): 2935-59.

Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: The SCORE project. Eur Heart J 2003; 24(11): 987-1003.

World Health Organization. Waist circumference and waist-hip ratio: Report of a WHO expert consultation. Geneva, Switzerland: WHO; 2011.

Hsieh SD, Yoshinaga H. Waist/height ratio as a

simple and useful predictor of coronary heart disease risk factors in women. Intern Med 1995; 34(12): 1147-52.

Ware LJ, Rennie KL, Kruger HS, Kruger IM, Greeff M, Fourie CM, et al. Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults. Nutr Metab Cardiovasc Dis 2014; 24(8): 900-7.

Seidell JC, Bjorntorp P, Sjostrom L, Sannerstedt R, Krotkiewski M, Kvist H. Regional distribution of muscle and fat mass in men-new insight into the risk of abdominal obesity using computed tomography. Int J Obes 1989; 13(3): 289-303.

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: Risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009; 53(21): 1925-32.

Gruberg L, Mercado N, Milo S, Boersma E, Disco C, van Es GA, et al. Impact of body mass index on the outcome of patients with multivessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II? Am J Cardiol 2005; 95(4): 439-44.

Hoffmans MD, Kromhout D, de Lezenne Coulander C. The impact of body mass index of 78,612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol 1988; 41(8): 749-56.

Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med 1995; 333(11): 677-85.

Lissner L, Bjorkelund C, Heitmann BL, Seidell JC, Bengtsson C. Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes Res 2001; 9(10): 644-6.

Okura T, Nakata Y, Yamabuki K, Tanaka K. Regional body composition changes exhibit opposing effects on coronary heart disease risk factors. Arterioscler Thromb Vasc Biol 2004; 24(5): 923-9.

Seidell JC, Han TS, Feskens EJ, Lean ME. Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus. J Intern Med 1997; 242(5): 401-6.

Snijder MB, Zimmet PZ, Visser M, Dekker JM, Seidell JC, Shaw JE. Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: The AusDiab Study. Int J Obes Relat Metab Disord 2004; 28(3): 402-9.

Mendelsohn ME. Protective effects of estrogen on the cardiovascular system. Am J Cardiol 2002; 89(12A): 12E-7E.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.