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Effect modification of general and central obesity by sex and age on cardiovascular outcomes: Targeted maximum likelihood estimation in the atherosclerosis risk in communities study.

TitleEffect modification of general and central obesity by sex and age on cardiovascular outcomes: Targeted maximum likelihood estimation in the atherosclerosis risk in communities study.
Publication TypeJournal Article
Year of Publication2021
AuthorsSaadati HMozafar, Sabour S, Mansournia MAli, Mehrabi Y, Nazari SSaeed Hash
JournalDiabetes Metab Syndr
Volume15
Issue2
Pagination479-485
Date Published2021 Mar-Apr
ISSN1878-0334
Abstract

BACKGROUND AND AIMS: To elucidate the effect modification of general and central obesity by sex and age on the risk of cardiovascular events.

METHODS: The analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities study. Obesity was defined with body mass index (BMI), waist-to-hip ratio (WHR) and body shape index (BSI) which categorized the participants as obese and non-obese. Targeted maximum likelihood estimation was used to estimate the risk ratio (RR) with the tmle package in R software.

RESULTS: After adjustment, the strongest effect of BMI on CHD was in females (RR (95%CI): 1.26 (1.11, 1.42)) and in age>54 (RR (95%CI): 1.16 (1.06, 1.27)) and for HF it was in age>54 (RR (95%CI): 1.18 (1.10, 1.26)) and in females (RR (95%CI): 1.17 (1.08, 1.28)). Regarding central obesity, WHR (RR (95%CI): 1.19 (1.05, 1.34)) had the strongest effects on CHD for males and BSI (RR (95%CI): 1.140 (1.02, 1.26)) for age ≤ 54, and for HF the WHR (RR (95%CI): 1.22 (1.10, 1.36)) and BSI (RR (95%CI): 1.18 (1.07, 1.30)) had the strongest effects for age≤54, respectively.

CONCLUSION: Among males and age≤54, WHR index was associated with a higher risk of CHD and HF while BMI was so for females and age>54.

DOI10.1016/j.dsx.2021.02.024
Alternate JournalDiabetes Metab Syndr
PubMed ID33662834