Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Epidemiology
Published in: European Journal of Epidemiology 8/2018

Open Access 01-08-2018 | META-ANALYSIS

Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose–response meta-analysis of prospective studies

Authors: Dagfinn Aune, Sabrina Schlesinger, Teresa Norat, Elio Riboli

Published in: European Journal of Epidemiology | Issue 8/2018

Login to get access

Abstract

Although overweight and obesity are established risk factors for some types of heart disease including ischemic heart disease, heart failure and atrial fibrillation, less is known about the association between adiposity and sudden cardiac death. We conducted a systematic review and meta-analysis of prospective studies to clarify the association between adiposity and risk of sudden cardiac death. PubMed and Embase databases were searched up to July 20th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. The summary RR was 1.16 (95% CI 1.05–1.28, I2 = 68%, n = 14) per 5 unit increment in BMI, and 1.82 (95% CI 1.61–2.07, I2 = 0%, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.03 (95% CI 0.93–1.15, I2 = 0%, n = 2) per 10 cm increase in waist circumference. The heterogeneity in the analysis of BMI and sudden cardiac death persisted across most subgroup analyses. The association was stronger among studies with longer follow-up compared to short follow-up and was observed in the European and American studies, but not in the Asian studies. There was a J-shaped association between BMI and sudden cardiac death and the lowest risk was observed in the normal weight range, however, the increased risk with a low BMI was attenuated among studies with a longer duration of follow-up. This meta-analysis suggest an increased risk of sudden cardiac death with increasing BMI and waist-to-hip ratio, however, further studies with stratification for smoking status are needed of waist circumference, weight changes and adiposity at younger ages.
Appendix
Available only for authorised users
Literature
1.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017;390:2627–2642.CrossRef
2.
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.CrossRefPubMedPubMedCentral
3.
Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.CrossRefPubMed
4.
Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156.CrossRefPubMedPubMedCentral
5.
Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776–86.CrossRefPubMed
6.
Aune D, Sen A, Norat T, et al. Body mass index, abdominal fatness and heart failure incidence and mortality: a systematic review and dose-response meta-analysis of prospective studies. Circulation. 2016;133:639–49.CrossRefPubMed
7.
World Cancer Research Fund/American Insitute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: a global perspective. Washington: AICR; 2007.
8.
Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. 2012;23:843–52.CrossRefPubMed
9.
Aune D, Navarro Rosenblatt DA, Chan DS, et al. Anthropometric factors and ovarian cancer risk: a systematic review and nonlinear dose-response meta-analysis of prospective studies. Int J Cancer. 2014;136:1888–98.CrossRefPubMed
10.
Aune D, Navarro Rosenblatt DA, Chan DS, et al. Anthropometric factors and endometrial cancer risk: a systematic review and dose-response meta-analysis of prospective studies. Ann Oncol. 2015;26:1635–48.CrossRefPubMed
11.
Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9:13–27.CrossRefPubMed
12.
Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–603.CrossRefPubMedPubMedCentral
13.
Stecker EC, Vickers C, Waltz J, et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol. 2006;47:1161–6.CrossRefPubMed
14.
Aune D, Sen A, Schlesinger S, et al. Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;31:181–92.CrossRef
15.
Wannamethee G, Shaper AG, Macfarlane PW, Walker M. Risk factors for sudden cardiac death in middle-aged British men. Circulation. 1995;91:1749–56.CrossRefPubMed
16.
Jouven X, Desnos M, Guerot C, Ducimetiere P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation. 1999;99:1978–83.CrossRefPubMed
17.
Kataoka M, Ito C, Sasaki H, Yamane K, Kohno N. Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes. Diabetes Res Clin Pract. 2004;64:51–8.CrossRefPubMed
18.
Chei CL, Iso H, Yamagishi K, Inoue M, Tsugane S. Body mass index and weight change since 20 years of age and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based Study. Int J Obes (Lond). 2008;32:144–51.CrossRef
19.
Laukkanen JA, Makikallio TH, Rauramaa R, Kiviniemi V, Ronkainen K, Kurl S. Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study. J Am Coll Cardiol. 2010;56:1476–83.CrossRefPubMed
20.
Ohira T, Maruyama M, Imano H, et al. Risk factors for sudden cardiac death among Japanese: the Circulatory Risk in Communities Study. J Hypertens. 2012;30:1137–43.CrossRefPubMed
21.
Bertoia ML, Allison MA, Manson JE, et al. Risk factors for sudden cardiac death in post-menopausal women. J Am Coll Cardiol. 2012;60:2674–82.CrossRefPubMed
22.
Lahtinen AM, Noseworthy PA, Havulinna AS, et al. Common genetic variants associated with sudden cardiac death: the FinSCDgen study. PLoS ONE. 2012;7:e41675.CrossRefPubMedPubMedCentral
23.
Karppi J, Laukkanen JA, Makikallio TH, Ronkainen K, Kurl S. Serum beta-carotene and the risk of sudden cardiac death in men: a population-based follow-up study. Atherosclerosis. 2013;226:172–7.CrossRefPubMed
24.
Laukkanen JA, Makikallio TH, Ronkainen K, Karppi J, Kurl S. Impaired fasting plasma glucose and type 2 diabetes are related to the risk of out-of-hospital sudden cardiac death and all-cause mortality. Diabetes Care. 2013;36:1166–71.CrossRefPubMedPubMedCentral
25.
Chiuve SE, Sun Q, Sandhu RK, et al. Adiposity throughout adulthood and risk of sudden cardiac death in women. JACC Clin Electrophysiol. 2015;1:520–8.CrossRefPubMedPubMedCentral
26.
Adabag S, Huxley RR, Lopez FL, et al. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study. Heart. 2015;101:215–21.CrossRefPubMed
27.
Eranti A, Aro AL, Kerola T, et al. Body mass index as a predictor of sudden cardiac death and usefulness of the electrocardiogram for risk stratification. Am J Cardiol. 2016;117:388–93.CrossRefPubMed
28.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.CrossRefPubMed
29.
30.
31.
Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301–9.CrossRefPubMed
32.
Bagnardi V, Zambon A, Quatto P, Corrao G. Flexible meta-regression functions for modeling aggregate dose-response data, with an application to alcohol and mortality. Am J Epidemiol. 2004;159:1077–86.CrossRefPubMed
33.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.CrossRefPubMed
34.
35.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.CrossRefPubMed
36.
Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality–beyond established causes. N Engl J Med. 2015;372:631–40.CrossRefPubMed
37.
Winslow UC, Rode L, Nordestgaard BG. High tobacco consumption lowers body weight: a Mendelian randomization study of the Copenhagen General Population Study. Int J Epidemiol. 2015;44:540–50.CrossRefPubMed
38.
Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. 1990;1:466–73.CrossRefPubMed
39.
Bes-Rastrollo M, Sabate J, Jaceldo-Siegl K, Fraser GE. Validation of self-reported anthropometrics in the Adventist Health Study 2. BMC Public Health. 2011;11:213.CrossRefPubMedPubMedCentral
40.
Weaver TW, Kushi LH, McGovern PG, et al. Validation study of self-reported measures of fat distribution. Int J Obes Relat Metab Disord. 1996;20:644–50.PubMed
41.
Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 2002;5:561–5.CrossRefPubMed
42.
Flegal KM, Shepherd JA, Looker AC, et al. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr. 2009;89:500–8.CrossRefPubMed
43.
Blew RM, Sardinha LB, Milliken LA, et al. Assessing the validity of body mass index standards in early postmenopausal women. Obes Res. 2002;10:799–808.CrossRefPubMed
44.
Dudina A, Cooney MT, Bacquer DD, et al. Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators. Eur J Cardiovasc Prev Rehabil. 2011;18:731–42.CrossRefPubMed
45.
Abdullah A, Peeters A, de Courten M, Stoelwinder J. The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin Pract. 2010;89:309–19.CrossRefPubMed
46.
Cupples LA, Gagnon DR, Kannel WB. Long- and short-term risk of sudden coronary death. Circulation. 1992;85:I11–8.PubMed
47.
Kannel WB, Cupples LA, D’Agostino RB. Sudden death risk in overt coronary heart disease: the Framingham Study. Am Heart J. 1987;113:799–804.CrossRefPubMed
48.
Cuspidi C, Rescaldani M, Sala C, Grassi G. Left-ventricular hypertrophy and obesity: a systematic review and meta-analysis of echocardiographic studies. J Hypertens. 2014;32:16–25.CrossRefPubMed
49.
50.
Falkner B, DeLoach S, Keith SW, Gidding SS. High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in African-American adolescents. J Pediatr. 2013;162:94–100.CrossRefPubMed
51.
Diez J. Effects of aldosterone on the heart: beyond systemic hemodynamics? Hypertension. 2008;52:462–4.CrossRefPubMed
52.
Rossi RC, Vanderlei LC, Goncalves AC, et al. Impact of obesity on autonomic modulation, heart rate and blood pressure in obese young people. Auton Neurosci. 2015;193:138–41.CrossRefPubMed
53.
Strandheim A, Halland H, Saeed S, et al. Obesity-associated metabolic changes influence resting and peak heart rate in women and men. Scand Cardiovasc J. 2015;49:337–43.PubMed
54.
Aune D, Sen A, O’Hartaigh B, et al. Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis. 2017;27:504–17.CrossRefPubMed
55.
56.
Plourde B, Sarrazin JF, Nault I, Poirier P. Sudden cardiac death and obesity. Expert Rev Cardiovasc Ther. 2014;12:1099–110.CrossRefPubMed
57.
Ouchi N, Kihara S, Funahashi T, Matsuzawa Y, Walsh K. Obesity, adiponectin and vascular inflammatory disease. Curr Opin Lipidol. 2003;14:561–6.CrossRefPubMed
58.
Wong C, Marwick TH. Obesity cardiomyopathy: pathogenesis and pathophysiology. Nat Clin Pract Cardiovasc Med. 2007;4:436–43.CrossRefPubMed
59.
Joshy G, Korda RJ, Attia J, Liu B, Bauman AE, Banks E. Body mass index and incident hospitalisation for cardiovascular disease in 158,546 participants from the 45 and Up Study. Int J Obes (Lond). 2014;38:848–56.CrossRef
60.
Danaei G, Lu Y, Singh GM, Carnahan E, Stevens GA, Cowan MJ, Farzadfar F, Lin JK, Finucane MM, Rao M, Khang YH. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2:634–47.CrossRef
61.
Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016;354:i4482.CrossRefPubMed
62.
Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med. 1987;147:1725–8.CrossRefPubMed
63.
Bigger JT Jr, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. 1984;69:250–8.CrossRefPubMed
64.
Anthony R, Daubert JP, Zareba W, et al. Mechanisms of ventricular fibrillation initiation in MADIT II patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2008;31:144–50.CrossRefPubMed
65.
Bharati S, Lev M. Cardiac conduction system involvement in sudden death of obese young people. Am Heart J. 1995;129:273–81.CrossRefPubMed
66.
Balsaver AM, Morales AR, Whitehouse FW. Fat infiltration of myocardium as a cause of cardiac conduction defect. Am J Cardiol. 1967;19:261–5.CrossRefPubMed
67.
Frank S, Colliver JA, Frank A. The electrocardiogram in obesity: statistical analysis of 1,029 patients. J Am Coll Cardiol. 1986;7:295–9.CrossRefPubMed
68.
Alpert MA, Terry BE, Cohen MV, Fan TM, Painter JA, Massey CV. The electrocardiogram in morbid obesity. Am J Cardiol. 2000;85(908–10):A10.
69.
O’Neal WT, Singleton MJ, Roberts JD, et al. Association between QT-interval components and sudden cardiac death: the ARIC Study (Atherosclerosis Risk in Communities). Circ Arrhythm Electrophysiol. 2017;10:e005485.CrossRefPubMedPubMedCentral
70.
Reinier K, Narayanan K, Uy-Evanado A, et al. Electrocardiographic markers and the left ventricular ejection fraction have cumulative effects on risk of sudden cardiac death. JACC Clin Electrophysiol. 2015;1:542–50.CrossRefPubMedPubMedCentral
71.
Aro AL, Reinier K, Rusinaru C, et al. Electrical risk score beyond the left ventricular ejection fraction: prediction of sudden cardiac death in the Oregon Sudden Unexpected Death Study and the Atherosclerosis Risk in Communities Study. Eur Heart J. 2017;38:3017–25.CrossRefPubMed
72.
Laukkanen JA, Di AE, Khan H, Kurl S, Ronkainen K, Rautaharju P. T-wave inversion, QRS duration, and QRS/T angle as electrocardiographic predictors of the risk for sudden cardiac death. Am J Cardiol. 2014;113:1178–83.CrossRefPubMed
73.
Alpert MA, Terry BE, Hamm CR, et al. Effect of weight loss on the ECG of normotensive morbidly obese patients. Chest. 2001;119:507–10.CrossRefPubMed
Metadata
Title
Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose–response meta-analysis of prospective studies
Authors
Dagfinn Aune
Sabrina Schlesinger
Teresa Norat
Elio Riboli
Publication date
01-08-2018
Publisher
Springer Netherlands
Published in
European Journal of Epidemiology / Issue 8/2018
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-017-0353-9

Other articles of this Issue 8/2018

European Journal of Epidemiology 8/2018 Go to the issue

META-ANALYSIS

Body mass index and age at natural menopause: an international pooled analysis of 11 prospective studies

REPRODUCTIVE EPIDEMIOLOGY

Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health

METHODS

Causal null hypotheses of sustained treatment strategies: What can be tested with an instrumental variable?

COMMENTARY

What indeed can be tested with an instrumental variable?

DEVELOPMENTAL EPIDEMIOLOGY

The impact of parity on life course blood pressure trajectories: the HUNT study in Norway

MORTALITY

Subjective social status and mortality: the English Longitudinal Study of Ageing