Cardiovascular risk factors, BMI and mortality in a cohort of Swiss males (1976-2001) with high-sum-assured life insurance cover.
ABSTRACT This long-term study investigates the influence of body mass index, blood pressure, smoking habits, impaired glucose metabolism and history of any disease on the mortality of Swiss males holding life insurance cover with high sums assured.
In a prospective study (1976-2001) including 22,927 Swiss insured males holding life insurance cover with high sums assured, the prevalence of overweight and obesity was compared with data from the general population. The relationship between BMI and all-cause mortality was assessed using a Cox proportional hazard model adjusted for age and calendar year, thereby controlling for mortality improvement over time. Multivariable models were used to investigate the impact of multiple cardiovascular risk factors on all-cause and cardiovascular mortality. The evolution of hazard ratios was assessed by dividing the observation period into two periods (1976-1985 vs 1986-2001).
The prevalence of overweight was 35.7% and of obesity 6.2%. The prevalence of both increased over time. The association between BMI and all-cause mortality showed a 'U'-shaped curve with the nadir at 22.0-23.9 kg/m2. Compared with this optimal range, a relative risk of 1.76 (CI 95%: 1.17-2.67) was found for a BMI in the range of 30.0-31.9 kg/m2, representing the lowest category of obese subjects. In the multivariable model, obese subjects had a hazard ratio of 1.76 (CI 95%: 1.34-2.30) compared against those with normal BMI. The hazard ratios for all-cause mortality associated with prehypertension, stage 1 and stage 2 hypertension were 1.58, 2.28 and 3.14, respectively, all of them being statistically significant. The results for cardiovascular mortality were more pronounced, however, with wider confidence intervals. Comparing the two observational periods, the hazard ratios for obese vs non-obese subjects were 1.57 (CI 95%: 1.08 to 2.28) in period 1 and 2.41 (CI 95%: 1.71-3.39) in period 2. Similarly, the hazard ratio for combined stages 1 and 2 hypertension vs the other categories of JNC7 were 1.52 (CI 95%: 1.15-2.01) and 1.96 (CI 95%: 1.49-2.58) for periods 1 and 2, respectively.
In this cohort of Swiss insured males holding life insurance cover with high sums assured, prevalence trends of elevated BMI are similar to those in the general population. The relative mortality risks associated with cardiovascular risk factors are higher than in the general population and, in the case of elevated BMI and high blood pressure, might exhibit an increase over time.
- SourceAvailable from: Jacob MufundaJournal of Human Hypertension 02/2007; 21(1):5-7. DOI:10.1038/sj.jhh.1002106 · 2.69 Impact Factor
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ABSTRACT: The association between body mass index (BMI) and survival has been described in various populations. However, the results remain controversial and information from low-prevalence Western countries is sparse. Our aim was to examine this association and its public health impact in Switzerland, a country with internationally low mortality rate and obesity prevalence. We included 9,853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983-1992) and could be followed up for survival until 2008 by using anonymous record linkage. Cox regression models were used to calculate mortality hazard ratios (HRs) and to estimate excess deaths. Independent variables were age, sex, survey wave, diet, physical activity, smoking, educational class. After adjustment for age and sex the association between BMI and all-cause mortality was J shaped (non-smokers) or U shaped (smokers). Compared to BMI 18.5-24.9, among those with BMI ≥ 30 (obesity) HR for all-cause mortality was 1.41 (95% confidence interval: 1.23-1.62), for cardiovascular disease (CVD) 2.05 (1.60-2.62), for cancer 1.29 (1.04-1.60). Further adjustment attenuated the obesity-mortality relationship but the associations remained statistically significant. No significant increase was found for overweight (BMI 25-29.9). Between 4 and 6.5% of all deaths, 8.8-13.7% of CVD deaths and 2.4-3.9% of cancer deaths could be attributed to obesity. Obesity, but not overweight was associated with excess mortality, mainly because of an increased risk of death from CVD and cancer. Public health interventions should focus on preventing normal- and overweight persons from becoming obese.European Journal of Epidemiology 06/2011; 26(8):647-55. DOI:10.1007/s10654-011-9593-2 · 5.15 Impact Factor
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ABSTRACT: Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths. Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured. Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.JAMA The Journal of the American Medical Association 01/2013; 309(1):71-82. DOI:10.1001/jama.2012.113905 · 30.39 Impact Factor