Prospective Studies Collaboration Lancet 2009; 373:

Slides:



Advertisements
Similar presentations
CGHR.ORG Twitter: CGHR_org 21 st century hazards of smoking and benefits of cessation in the United States Jha P, Ramasundarahettige C, Landsman V, Thun.
Advertisements

National and subnational mortality effects of major metabolic risk factors and smoking in Iran: a comparative risk assessment Scientific Webinars Farzadfar.
Body Mass Index – BMI Going for the 3 Increases: Increase in Health, Increase in Happiness & Increase in Energy Strategies for Success in Weight Management.
Date of download: 6/17/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Major Lipids, Apolipoproteins, and Risk of Vascular.
Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Usual Blood Pressure and Risk of New-Onset Diabetes:
Cardiovascular Risk: A global perspective
Date of download: 9/17/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/AHA 2011 Expert Consensus Document on Hypertension.
Dr John Cox Diabetes in Primary Care Conference Cork
Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP
The smoking epidemic and lung cancer in the EU
Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population-level cohort study  Dr Jack R W Brownrigg,
US cost-effectiveness of simvastatin in 20,536 people at different levels of vascular disease risk: randomised placebo-controlled trial UK Medical Research.
Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials Ungroup once.
Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck
Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies  The Emerging.
Prospective Studies Collaboration Lancet 2009; 373:
Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck
REVEAL: Randomized placebo-controlled trial of anacetrapib in 30,449 patients with atherosclerotic vascular disease Louise Bowman on behalf of the HPS.
Copyright © 2007 American Medical Association. All rights reserved.
Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies  Collaborative Group on Epidemiological.
Comparison of baseline characteristics in participants who subsequently had an incident cardiovascular event or new-onset diabetes in the Prospective.
Volume 388, Issue 10059, Pages (November 2016)
Copyright © 2012 American Medical Association. All rights reserved.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults Risks and Assessment NHLBI Obesity Education.
Risk factor thresholds: their existence under scrutiny
Cardiometabolic Health Check
Cardiovascular risk factors: are they useful screening tests?
Body Mass Index, Sex, and Cardiovascular Disease Risk Factors Among Hispanic/Latino Adults: Hispanic Community Health Study/Study of Latinos by Robert.
Teaching Tool: Blood Pressure Classification
Progress and Promise in RAAS Blockade
Heart Disease and Stroke Statistics — 2004 Update
Baseline characteristics of HPS participants by prior diabetes
Volume 375, Issue 9709, Pages (January 2010)
The results of the SHARP trial
Reflections on Physical Activity and Health: What Should We Recommend?
Body-mass index and all-cause mortality – Authors' reply
Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies  Collaborative Group on Epidemiological.
Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies  The Emerging.
by Peter Ueda, Thomas Wai-Chun Lung, Philip Clarke, and Goodarz Danaei
Aspirin in the primary and secondary prevention of vascular disease: collaborative meta- analysis of individual participant data from randomised trials 
by Peter Ueda, Thomas Wai-Chun Lung, Philip Clarke, and Goodarz Danaei
Description of studies for pooled analyses
Body-mass index and all-cause mortality – Authors' reply
Lowering of SBP by 20 mm Hg Reduces Cardiovascular Risk by Half
Volume 383, Issue 9927, Pages (April 2014)
Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies  Prospective Studies Collaboration  The.
Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies 
Howell S.J. , Sear J.W. , Foëx P   British Journal of Anaesthesia 
Body-mass index and mortality – Authors' reply
Volume 379, Issue 9822, Pages (March 2012)
Volume 375, Issue 9725, Pages (May 2010)
Ratio of relative risks of heart disease and stroke associated with higher blood pressure, smoking, type I and II diabetes, and higher cholesterol in women.
Body-mass index, blood pressure, and cause-specific mortality in India: a prospective cohort study of 500 810 adults  Vendhan Gajalakshmi, PhD, Ben Lacey,
Volume 379, Issue 9822, Pages (March 2012)
Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies  The Emerging.
Baseline Characteristics of the Subjects*
The volume per centre plotted against clinical outcomes which included Hospital Anxiety and Depression Scale (HADS) score, exercise 150 min, smoking, body.
Volume 73, Issue 8, Pages (April 2008)
Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20 536 high-risk individuals: a randomised.
1994 Methodology The percent of U.S. adults who are obese or who have diagnosed diabetes was determined by using data from the Behavioral Risk Factor Surveillance.
The results of the SHARP trial
Volume 75, Issue 1, Pages (January 2009)
Adjusted HRs (95% CIs) for all-cause mortality associated with BMI by smoking status in men and women and by CHD, type 2 diabetes, and cancer status at.
Adjusted HRs (95% CIs) for all-cause mortality associated with body fat percentage by smoking status in men and women and by CHD, type 2 diabetes, and.
ROC curves for cardiovascular events, all-cause mortality, and disease progression. ROC curves for cardiovascular events, all-cause mortality, and disease.
Subgroup analysis of associations between egg consumption and risk of incident cardiovascular disease (CVD), ischaemic heart disease (IHD), haemorrhagic.
Hazard ratios, with 95% confidence intervals as floating absolute risks, as estimate of association between category of updated mean haemoglobin A1c concentration.
Association of body mass index with all-cause mortality in diabetes and non-diabetes populations, by smoking status. Association of body mass index with.
Associations between walking pace (three groups) and all-cause (A), cardiovascular disease (B) and cancer (C) mortality by age group (
HR for mortality in ischemic heart disease.
Presentation transcript:

Prospective Studies Collaboration Lancet 2009; 373: 1083-96 Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies Prospective Studies Collaboration Lancet 2009; 373: 1083-96

Blood pressure, cholesterol and BMI 160 5 M Non-HDL-C Systolic M 140 4 Ratio of means (non-HDL-C/HDL-C) F F 120 M 3 F mmol/L (or ratio) mm Hg 100 2 F M Diastolic Blood pressure and cholesterol fractions versus BMI at baseline in the range 15–50 kg/m². Adjusted for baseline age, baseline smoking status and study. Numerical values are shown for 20–22·5 kg/m², for 30–32·5 kg/m², and for the extreme BMI groups. Boundaries of BMI groups are indicated by tick marks. 95% CIs are not shown, but most are narrower than the heights of the plotted symbols. Blood pressure on left (in 533 242 males and 348 790 females). Blood cholesterol fractions on right (in 62 364 males and 52 575 females with total and HDL cholesterol both measured); dashed line indicates the ratio of mean non-HDL cholesterol to mean HDL cholesterol (mean of the individual ratios is about 8–12% greater: see next slide). HDL-C 80 F 1 M 15 25 35 50 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1a & b, Lancet 2009; 373: 1083-96

Ratio non-HDL:HDL cholesterol and BMI 5 M Mean of ratios 4 Ratio of means 3 Ratio F 2 (Mean of ratios ~10% higher than ratio of means) Cholesterol fractions versus BMI at baseline in the range 15–50 kg/m². Blood cholesterol fractions (in 62 364 males and 52 575 females with total and HDL cholesterol both measured) versus BMI. Symbols connected by dashed line indicates the ratio of mean non-HDL cholesterol to mean HDL cholesterol (as in the previous slide); symbols not connected by any line indicate the mean of the individual ratios. Conventions as in the previous slide. 1 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1b variant, Lancet 2009; 373: 1083-96

Drinking, smoking, diabetes and BMI Male Female 100 100 80 80 Drinking 60 60 Prevalence% 40 40 Drinking Smoking Drinking, smoking and diabetes versus BMI at baseline in the range 15–50 kg/m². Adjusted for baseline age, baseline smoking status (apart from the smoking findings), and study. Numerical values are shown for 20–22·5 kg/m², for 30–32·5 kg/m², and for the extreme BMI groups. Boundaries of BMI groups are indicated by tick marks. 95% CIs are not shown, but most are narrower than the heights of the plotted symbols. At left are the prevalences in males for alcohol drinking (168 283), cigarette smoking (334 496), and diabetes (378 854). At right are the prevalences in females for alcohol drinking (129 301), cigarette smoking (226 307), and diabetes (319 401). 20 20 Smoking Diabetes Diabetes 15 25 35 50 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1c & d, Lancet 2009; 373: 1083-96

All-cause mortality and BMI 64 Male 32 Annual deaths per 1000 Female 16 & 95% CI (floated so matches PSC rate at ages 35-79) All-cause mortality versus BMI for each sex in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–89 years, adjusted for age at risk, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the PSC mortality rate at ages 35–79 years. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. Dotted vertical line indicates 25 kg/m² (boundary between upper and lower BMI ranges in this report). 8 4 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Fig 2, Lancet 2009; 373: 1083-96

IHD and stroke mortality and BMI 8 IHD Annual deaths per 1000 4 Stroke 2 & 95% CI (floated so matches PSC rate at ages 35-79) Ischaemic heart disease and stroke mortality versus BMI in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–89 years, adjusted for age at risk, sex, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the PSC mortality rate at ages 35–79 years. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 1 0·5 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Fig 3, Lancet 2009; 373: 1083-96

Main mortality categories and BMI Male Female 14 14 Vascular 12 12 Annual deaths per 1000 10 10 8 8 6 6 & 95% CI (floated so matches EU rate at ages 35-79) Vascular Cancer (other specified) Mortality rates at ages 35–79 years for main disease categories versus BMI in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–79 years, adjusted for age at risk, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the age-standardised European Union (15 countries) mortality rate at ages 35–79 years in 2000. Neoplastic mortality is split into the types most strongly associated with smoking (cancers of the lung and upper aerodigestive tract) and all other specified types. By contrast with figures 2–4, risk is indicated on an additive rather than multiplicative scale, with floated mortality rates shown above or below each symbol. The estimates for 35–50 kg/m² are based on limited data, so lines connecting to those estimates are dashed. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 4 4 Cancer (other specified) Cancer (lung, mouth, pharynx, larynx, oes.) 2 2 Cancer (lung, mouth, pharynx, larynx, oes.) Resp. Respiratory 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Fig 5, Lancet 2009; 373: 1083-96

All-cause mortality and BMI, by smoking 30 Current cigarette smoker 25 Annual deaths per 1000 20 Never smoked regularly 15 & 95% CI (floated so matches EU rate at ages 35-79) 10 (N.B. The vertical separation of the curves underestimates effects of lifelong cigarette smoking) All-cause mortality at ages 35–79 years versus BMI in the range 15–50 kg/m², by smoking status (excluding the first 5 years of follow-up). Relative risks at ages 35–79 years, adjusted for age at risk, sex, and study, were multiplied by a common factor (ie, floated) so that the mean for all participants (including ex-smokers and anyone with missing smoking data) matches the European rate at ages 35–79 years in 2000. Results for ex-smokers and those with missing smoking data not shown (but are, taken together, only slightly above those for never smokers). Note that many smokers were at only limited risk, since they had not smoked many cigarettes during early adult life, or had stopped shortly after the baseline survey. Risk is indicated on an additive rather than multiplicative scale. The estimates for 35–50 kg/m² are based on limited data, so lines connecting to those estimates are dashed. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 5 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex and study; 1st 5 years of follow-up excluded Fig 6, Lancet 2009; 373: 1083-96

Lifespan and BMI in western Europe, year 2000 Male Female 100 100 88% 80 77% 80 84% 69% % alive 60 60 Yearly dots 40 40 BMI range, kg/m2 BMI versus lifespan in western Europe, year 2000 (3 main BMI categories). Estimated effects of the BMI that would be reached by about 60 years of age on survival from age 35 years, identifying European Union (EU) mortality rates in 2000 with those for BMI 25–30 kg/m² and combining the disease-specific EU mortality rates with disease-specific relative risks (for details, see webappendix pp 18–20). The absolute differences in median survival (but probably not in survival to age 70 years) should be robust to changes in mortality rates, and therefore generalisable decades hence. 22.5-25 (mean 24) 20 20 25-30 (mean 27) 30-35 (mean 32) 40 50 60 70 80 90 100 40 50 60 70 80 90 100 Age (years) Causal PSC relative risks applied to EU mortality rates Fig 7 variant, Lancet 2009; 373: 1083-96

Lifespan and BMI in western Europe, year 2000 Male Female 100 100 88% 80 77% 80 72% % alive 60 60 Yearly dots 49% 40 BMI range, kg/m2 40 22.5-25 (mean 24) 25-30 BMI versus lifespan in western Europe, year 2000 (3 main and 2 higher BMI categories). Estimated effects of the BMI that would be reached by about 60 years of age on survival from age 35 years, identifying European Union (EU) mortality rates in 2000 with those for BMI 25–30 kg/m² and combining the disease-specific EU mortality rates with disease-specific relative risks (for details, see webappendix pp 18–20). The absolute differences in median survival (but probably not in survival to age 70 years) should be robust to changes in mortality rates, and therefore generalisable decades hence. (Note that the 2 higher BMI categories account for just 2% of PSC participants, and so are indicated by dashed lines.) 20 30-35 (mean 32) 20 35-40 40-50 (mean 43) 40 50 60 70 80 90 100 40 50 60 70 80 90 100 Age (years) Causal PSC relative risks applied to EU mortality rates Fig 7, Lancet 2009; 373: 1083-96

Comparison with smoking in the British Doctors’ Study British Doctors’ Study. Survival from age 35 for continuing cigarette smokers and lifelong non-smokers among UK male doctors born 1900-1930, with percentages alive at each decade of age. From figure 3 in Doll, Peto et al., BMJ 2004: 328: 1519-33

All-cause mortality and BMI by smoking Male (35-69 years) Female (35-69 years) 20 20 Current cigarette smoker 15 15 Annual deaths per 1000 Never smoked regularly Current cigarette smoker 10 10 & 95% CI (floated so matches EU rate at ages 35-69) All-cause mortality at age 35-69 years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). For 35-50 kg/m2, only the upper or only the lower part of the CI is shown. Never smoked regularly 5 5 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7a & b, Lancet 2009; 373: 1083-96

All-cause mortality and BMI by smoking Male (70-79 years) Female (70-79 years) 100 100 Current cigarette smoker Annual deaths per 1000 75 75 Never smoked regularly Current cigarette smoker 50 50 & 95% CI (floated so matches EU rate at ages 70-79) Never smoked regularly All-cause mortality at age 70-79 years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). For 35-50 kg/m2, only the upper or only the lower part of the CI is shown. 25 25 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7c & d, Lancet 2009; 373: 1083-96

Vascular mortality and BMI by smoking Male (35-69 years) Female (35-69 years) 6 6 Current cigarette smoker Annual deaths per 1000 4 4 Never smoked regularly Current cigarette smoker & 95% CI (floated so matches EU rate at ages 35-69) 2 2 Vascular mortality at age 35-69 years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). Results for 35-50 kg/m2 not plotted because of small numbers of deaths. Never smoked regularly 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8a & b, Lancet 2009; 373: 1083-96

Vascular mortality and BMI by smoking Male (70-79 years) Female (70-79 years) 30 30 Current cigarette smoker Annual deaths per 1000 20 Never smoked regularly 20 Current cigarette smoker & 95% CI (floated so matches EU rate at ages 35-79) Never smoked regularly 10 10 Vascular mortality at age 70-79 years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). Results for 35-50 kg/m2 not plotted because of small numbers of deaths. 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8c & d, Lancet 2009; 373: 1083-96