Adolescent body mass index and cardiovascular disease-specific mortality by midlife

Context: As opposed to coronary heart disease (CHD) mortality, cardiovascular mortality attributed to non-CHD causes has increased. Objective: To evaluate the association of body mass index (BMI) in late adolescence with mortality attributed to non-CHD cardiovascular sequelae. Design and Setting: A nationwide cohort. Participants: A total of 2,294,139 adolescents examined between 1967 and 2010. Interventions: Height and weight were measured at age 17. All cardiovascular disease-specific outcomes, coded by the Central Bureau of Statistics from death notifications as the underlying cause of death, were obtained by linkage. Cox hazards models were applied. Main Outcome Measurements: Death attributed to fatal arrhythmias, hypertensive heart disease, cardiomyopathies, arterial disease, heart failure, and pulmonary embolism. Results: During 42,297,007 person-years of follow-up, there were 3178 deaths due to cardiovascular causes, of which 279, 122, 121, 114, 94, and 70 were attributed to the main outcomes, respectively. BMI was positively associated with all study outcomes with hazard ratios (HRs) per unit increment in BMI ranging from 1.09 [95% confidence interval (CI): 1.03 to 1.16] for arterial disease to 1.16 (95% CI: 1.11 to 1.21) for hypertensive heart disease. When BMI was treated as a categorical variable, a graded increase in risk was evident from the high-normal (22.0 to <25.0 kg/m²) to the overweight to the obese categories, with HRs of 1.4, 1.7, and 3.7 for arrhythmias; 1.9, 4.1, and 8.0 for hypertensive heart disease; 1.5, 2.4, and 4.0 for cardiomyopathies, 2.7, 5.0, and 3.5; for arterial disease, 1.7, 2.7, and 5.4 for heart failure; and 1.3, 1.8, and 3.0 for pulmonary embolism. Findings persisted in extensive sensitivity analyses. Conclusions: Adolescent BMI within the accepted normal range is associated with non-CHD nonstroke cardiovascular outcomes.