Endocrinol Metab.  2021 Oct;36(5):1029-1041. 10.3803/EnM.2021.1197.

Cardiovascular Outcomes of Obesity According to Menopausal Status: A Nationwide Population-Based Study

• Koo BK
• Park SH
• Han K
• Moon MK

• KMID: 2521951
• DOI: http://doi.org/10.3803/EnM.2021.1197

Abstract

Background
We estimated the effect of obesity on the incidence of cardiovascular disease (CVD) and mortality in women according to menopausal status.
Methods
Women aged 40 to 69 years under routine health check-ups provided by the National Health Insurance Service in 2009 were followed up till 2018 (n=2,208,559).
Results
In premenopausal women, a significant increment of mortality rate was found in underweight and obesity class II (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.67; and HR, 1.25; 95% CI, 1.12 to 1.39) compared to normal body mass index (BMI); overweight and obesity class I did not affect mortality rate. In postmenopausal women, obesity as well as overweight status reduced the risk of mortality compared to normal BMI (HR, 0.86; 95% CI, 0.83 to 0.88; and HR, 0.84; 95% CI, 0.82 to 0.86). By contrast, there was a linear association between CVD and BMI above the normal range irrespective of menopausal status, which was attenuated in diabetic women.
Conclusion
The current study replicated the J-shaped relationship between BMI and mortality, being more prominent in the postmenopausal group. The risk of CVD was linearly increased as BMI was increased above the normal range irrespective of menopausal status.

Keyword

Obesity; Obesity; abdominal; Body mass index; Waist circumference; Cardiovascular diseases; Mortality

Figure

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  Fig. 1 Consort diagram for study population. MI, myocardial infarction.

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  Fig. 2 The risk of myocardial infarction, stroke, and mortality during the follow-up period according to body mass index and waist circumference. Hazard ratios for myocardial infarction (A), stroke (B) and mortality (C) according to body mass index and waist circumference (D, E, F, respectively) after adjustment for age, smoking history, alcohol consumption, regular exercise, low income, hypertension, dyslipidemia, chronic kidney disease, and diabetes mellitus in premenopausal (circle) and postmenopausal women (square). CI, confidence interval.

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  Fig. 3 The risk of myocardial infarction, stroke, and mortality during the follow-up period according to body mass index, diabetes mellitus (DM), and menopausal status. Hazard ratios for myocardial infarction (A), stroke (B), and mortality (C) according to body mass index after adjustment for age, smoking history, alcohol consumption, regular exercise, low income, hypertension, dyslipidemia, and chronic kidney disease in premenopausal (black) and postmenopausal (grey) women with (square) and without DM (circle). CI, confidence interval.

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