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BOSTON — Individuals who lived with obesity over a 10-year-period were 23%-60% more likely to experience a cardiovascular event than those who maintained a relatively healthy body mass index (BMI), according to new research presented at the 2024 Annual Endocrine Society annual meeting, held in Boston.

Maintaining excess weight over time was associated with an elevated risk for heart attack and stroke, while one-time elevated BMI measurements were not.

"I see that as a glass half full," said Alexander Turchin, MD, of Brigham and Women's Hospital, Boston, who led the research. "If somebody has excess weight, there is an opportunity for them — if they lower their weight — to decrease the subsequent risk of these cardiovascular events."

In this study, researchers used data from the Nurses' Health Study and the Health Professionals Follow-Up Study to identify individuals who had a recorded BMI > 25 at least once from 1990 to 1999. Researchers calculated the cumulative time with excess weight as area under the curve of BMI above 25 between 1990 and 1999, divided by 10. 

They then followed these patients over the next two decades (2000-2020) to document incident cardiovascular events including heart attack, stroke, and cardiovascular death. Researchers compared individuals with the highest excess weight exposure over a decade (average annual BMI, 30.6) with those having the lowest excess weight exposure (average annual BMI, 25.7).

The analysis included 109,259 women and 27,239 men. At baseline in 1990, participants were aged, on an average, 48 years and had a BMI of 27. Over 90% of participants were White individuals, 5% had atherosclerotic cardiovascular disease, 2.6% had type 2 diabetes, and 47.7% previously smoked.

From 2000-2020, there were 12,048 (8.8%) cardiovascular events. After adjusting for demographic factors and comorbidities, researchers found that an elevated BMI at baseline was not associated with an increased risk for cardiovascular events; rather, excess weight over time increased risk, particularly for younger patients. For this study, researchers used the participants' age in 1990 as their baseline.

For individuals who had obesity for over a decade, cardiovascular risk was highest in women aged < 35 years in 1990 (hazard ratio [HR], 1.60; 95% CI, 1.05-2.44), followed by men aged 35-50 years (HR, 1.57; 95% CI, 1.22-2.03), women aged 35-50 years (HR, 1.27; 95% CI, 1.01-1.58), and men aged 50-65 years (HR, 1.23; 95% CI, 1.02-1.48).

There were no data on men aged < 35 years in this analysis. Interestingly, there was not a detectable excess risk in women aged > 50 years and men aged > 65 years living with obesity.

While this result was not necessarily expected going into the research, "other literature that looked at risks for longitudinal exposure to excess weight for other outcomes such as cancer and diabetes [have seen] similar effects: The effect is greater on younger individuals," Turchin said.

The insights from this study and similar ones are key in "moving the needle for treatment for patients", said Gitanjali Srivastava, MD, of the Vanderbilt University Medical Center in Nashville, Tennessee, who moderated the research session.

"[The study] does highlight that if there is way that we can address BMI in adults with early intervention, there is a chance that you may actually reduce cardiovascular risk and morbidity."

The study was funded by Eli Lilly and the National Institutes of Health. Turchin reported receiving consulting fees from Novo Nordisk and Proteomics International and grant funding from Eli Lilly and Novo Nordisk. Srivastava consults for Novo Nordisk, Eli Lilly, and Rhythm Pharmaceuticals. She reported receiving research grant support from Eli Lilly.