Established cardiovascular disease in people living with overweight or obesity is associated with more illness, death and medical costs than obesity alone, according to a UK study of more than 420,000 adults
Adults with existing cardiovascular disease and overweight or obesity are five times more likely to suffer a stroke and four times more likely to suffer a heart attack than those with extreme obesity.
Adults at high cardiovascular risk and living with overweight or obesity experience a greater number of cardiovascular events (such as heart attacks and strokes), are at greater risk of dying prematurely, and have significantly higher health care costs than those living with obesity without cardiovascular disease, according to a study of more than 420,000 adults living in north-west London, which will be presented at this year’s European Congress on Obesity (ECO) in Dublin, Ireland (May 17-20).
Dr. Jonathan Pearson-Stuttard of Lane Clark & Peacock, London, United Kingdom, led the study together with colleagues at Novo Nordisk, Denmark, manufacturer of diabetes and obesity drugs and sponsor of the study.
“These findings illustrate the substantial impact of living with overweight or obesity and heart and circulatory disease on individuals, population health, and health care systems as a whole,” says Dr. Pearson-Stuttard. “As the prevalence of obesity increases, the frequency of obesity-related complications, such as heart disease and stroke, also increases in this group. This increased risk of adverse outcomes can be prevented and controlled through a combination of improving key risk factors, such as poor diet and smoking, along with effective control of blood pressure, cholesterol and glucose. Doing so would not only improve the number of years lived in good health, but would also reduce health care costs and improve economic productivity.”
For the study, researchers analyzed at least 10 years of de-identified health care data from 429,358 adults (age 18 and older) in the Discover database, which contains information on 2.8 million patients from primary care records. and linked secondary schools in north-west London, who had been diagnosed with obesity or were living with overweight and obesity and high cardiovascular risk between 2004 and 2019 (see table 1 in notes to editors).
They extracted data from 27,313 adults at high cardiovascular risk and high BMI (over 45 years of age with a BMI of 27 kg/m² or more and who had at least one previous heart attack, stroke, or peripheral artery disease; see Table 1 in notes to editors).
Adults with obesity were divided into class 1 (BMI 30-35 kg/m²; 278,782 individuals, average age 43 years, 51% women), class II (BMI 35-40 kg/m²; 80,621 individuals, average age 43 years, 61% women), or class III (BMI of 40 kg/m² or more; 42,642 individuals, average age 41, 65% women).
The researchers compared the incidence of cardiovascular events, death, and healthcare costs (standardized to 2019 prices) in people living with obesity and those at high cardiovascular risk. All results were age-standardized according to the European standard population (per 100,000 person-years).
Between 2015 and 2019, adults at high cardiovascular risk had a much higher incidence of strokes, heart attacks, major adverse cardiovascular events, and acute heart failure events than any of the individual obesity groups.
For example, adults at high cardiovascular risk were five times more likely to have a stroke than those living with class III obesity (1,148 per 100,000 person-years vs. 238 per 100,000 person-years) and five times more likely to suffer a major adverse cardiovascular event than those with class 1 obesity (2,812 person-years vs. 513 per 100,000 person-years).
However, the frequency of all cardiovascular events increased with each successive obesity class.
Similarly, the study found that cardiovascular disease-related mortality contributed to more than a quarter (27%) of overall deaths in the high cardiovascular risk group, but only about a fifth (17-20%) of total deaths in obesity groups (see figure 2 in notes to editors).
Furthermore, death from any cause was four times higher in the high cardiovascular risk group compared to the obesity class I group, and more than double that in obesity class III.
The analysis also found that the annual healthcare costs for a person at high cardiovascular risk were more than double those of a person with class I or class II obesity (£2,856 vs £1,182 and £1,390, respectively); and 75% higher than an individual living with class III obesity (£1,632; see figure 3 in notes to editors).
Inpatient admissions and prescription drug use were the primary drivers of healthcare costs across all groups, accounting for 71% of total costs in adults at high cardiovascular risk and 61% in adults with class obesity. 1.
“Like overweight and obesity, cardiovascular disease and its complications are largely preventable,” says Dr. Pearson-Stuttard. “The COVID-19 pandemic highlighted the value of population health to economic prosperity. Our analyzes highlight that the risk of adverse outcomes is not equal within populations. “Efforts aimed at more effectively managing chronic diseases and preventing complications would materially help reduce demand for acute healthcare services and lead to improved health and prosperity in communities.”
The study has several limitations, including that it was observational and cannot prove causality and cannot rule out the likelihood of selection bias, which is a common limitation of real-world evidence. For example, the influence of race and ethnicity on the risk of developing CVD may have influenced the results. Finally, the COVID-19 pandemic severely disrupted health systems and the analysis period was cut short at the end of 2019.
