Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk
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To evaluate the risk of CVD and all-cause mortality at different BMI levels in conjunction with weight change prior to diagnosis of T2DM in a multi-ethnic population.
Longitudinal study of 51,455 patients with T2DM and without a history of comorbid diseases at diagnosis. Weight changes prior to diagnosis of T2DM were evaluated, and the risk of CVD and all-cause mortality at different BMI levels among three ethnic groups estimated using treatment effects model.
White Europeans (WE), African-Caribbeans (AC), and South Asians (SA) were mean 52, 49, and 47 years with a mean BMI of 33.0, 32.0, and 30.0 kg/m2 at diagnosis, respectively. Among WE, normal weight patients developed CVD significantly earlier by 0.5 years (95% CI 0.1, 0.9 years; p = 0.018) compared to obese patients. Furthermore, those with normal body weight at diagnosis were significantly more likely to die earlier by 0.6 years (95% CI 0.03, 1.2 years; p = 0.037) among WE and by 2.5 years (95% CI 0.3, 4.6 years; p = 0.023) among SA compared to their respective obese patients. However, BMI at diagnosis was not associated with increased risk of CVD and death among AC.
This study suggests a paradoxical association of BMI with cardiovascular and mortality risks in different ethnic groups, which may partially be driven by different cardiovascular and glycaemic risk profiles at diagnosis.
KeywordsBody mass index Type 2 diabetes Mortality Ethnicity Weight change pattern
Melbourne EpiCentre gratefully acknowledges the support from the Australian Government’s National Collaborative Research Infrastructure Strategy (NCRIS) initiative through Therapeutic Innovation Australia.
SKP and ESOA conceived the idea and contributed to the study design. ESOA conducted the data extraction, data manipulation, and statistical analyses and developed the first draft of the manuscript. SKP contributed to the statistical analyses and had full access to all the data in the study and is the guarantor, taking responsibility for the integrity of the data and the accuracy of the data analysis. ESOA, KKR, and SKP were involved in writing the paper and had final approval of the submitted and published versions.
National Health and Medical Research Council of Australia (GNT1063477).
Compliance with ethical standards
Conflict of interest
SKP has acted as a consultant and/or speaker for Novartis, GI Dynamics, Roche, AstraZeneca, Guangzhou Zhongyi Pharmaceutical and Amylin Pharmaceuticals LLC. He has received grants in support of investigator and investigator-initiated clinical studies from Merck, Novo Nordisk, AstraZeneca, Hospira, Amylin Pharmaceuticals, Sanofi Aventis and Pfizer. KKR has acted as a speaker or consultant for Abbvie, Amgen, Pfizer, Astra Zeneca, Sanofi Resverlogix, Regeneron, Esperion, ACKCEA, Medicines Company, BI, Novo Nordisk. ESOA has no conflicts of interest to declare.
Statement of human and animal rights
This article does not contain any studies with human or animal subjects performed by the any of the authors.
- 1.Carnethon MR, De Chavez PJD, Biggs ML, Lewis CE, Pankow JS, Bertoni AG, Golden SH, Liu K, Mukamal KJ, Campbell-Jenkins B, Dyer AR (2012) Association of weight status with mortality in adults with incident diabetes. JAMA 308(6):581–590. https://doi.org/10.1001/jama.2012.9282 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Logue J, Walker JJ, Leese G, Lindsay R, Mcknight J, Morris A, Philip S, Wild S, Sattar N, on behalf of the Scottish Diabetes Research Network Epidemiology Group (2013) Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality. Diabetes Care 36(4):887–893. https://doi.org/10.2337/dc12-0944 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Li W, Johnson J, Heymsfield SB, Cefalu WT, Ryan DH, Hu G (2014) Body mass index and the risk of all-cause mortality among patients with type 2 diabetes. Circulation 130(24):2143–2151. https://doi.org/10.1161/circulationaha.114.009098 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Tillin T, Sattar N, Godsland IF, Hughes AD, Chaturvedi N, Forouhi NG (2015) Ethnicity-specific obesity cut-points in the development of type 2 diabetes—a prospective study including three ethnic groups in the United Kingdom. Diabet Med 32(2):226–234. https://doi.org/10.1111/dme.12576 CrossRefPubMedGoogle Scholar
- 14.Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, Deanfield J, Smeeth L, Timmis A, Hemingway H (2015) Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 3(2):105–113. https://doi.org/10.1016/S2213-8587(14)70219-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.U.K. Prospective Diabetes Study Group (1998) Ethnicity and cardiovascular disease: the incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type 2 diabetes (U.K. Prospective Diabetes Study 32). Diabetes Care 21(8):1271–1277. https://doi.org/10.2337/diacare.21.8.1271 CrossRefGoogle Scholar
- 17.Bellary S, O’Hare JP, Raymond NT, Mughal S, Hanif WM, Jones A, Kumar S, Barnett AH (2010) Premature cardiovascular events and mortality in South Asians with type 2 diabetes in the United Kingdom Asian Diabetes Study—effect of ethnicity on risk. Curr Med Res Opin 26(8):1873–1879. https://doi.org/10.1185/03007995.2010.490468 CrossRefPubMedGoogle Scholar
- 18.George J, Mathur R, Shah AD, Pujades-Rodriguez M, Denaxas S, Smeeth L, Timmis A, Hemingway H (2017) Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: associations in a linked electronic health record cohort of 1 million patients. PLoS One 12(6):e0178945. https://doi.org/10.1371/journal.pone.0178945 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Paul SK, Owusu Adjah ES, Samanta M, Patel K, Bellary S, Hanif W, Khunti K (2017) Comparison of body mass index at diagnosis of diabetes in a multi-ethnic population: a case–control study with matched non-diabetic controls. Diabetes Obes Metab 19(7):1014–1023. https://doi.org/10.1111/dom.12915 CrossRefPubMedGoogle Scholar
- 27.Ho AK, Bartels CM, Thorpe CT, Pandhi N, Smith MA, Johnson HM (2016) achieving weight loss and hypertension control among obese adults: a US Multidisciplinary Group Practice Observational Study. Am J Hypertens 29(8):984–991. https://doi.org/10.1093/ajh/hpw020 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Austin PC, Stuart EA (2015) The performance of inverse probability of treatment weighting and full matching on the propensity score in the presence of model misspecification when estimating the effect of treatment on survival outcomes. Stat Methods Med Res 26(4):1654–1670. https://doi.org/10.1177/0962280215584401 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Wright AK, Kontopantelis E, Emsley R, Buchan I, Sattar N, Rutter MK, Ashcroft DM (2016) Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Diabetes Care. https://doi.org/10.2337/dc16-1616 PubMedCrossRefGoogle Scholar
- 36.Penno G, Solini A, Bonora E, Orsi E, Fondelli C, Zerbini G, Trevisan R, Vedovato M, Cavalot F, Laviola L (2018) Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol 55(6):603–612. https://doi.org/10.1007/s00592-018-1133-z CrossRefPubMedGoogle Scholar
- 37.Owusu Adjah ES, Bellary S, Hanif W, Patel K, Khunti K, Paul SK (2018) Prevalence and incidence of complications at diagnosis of T2DM and during follow-up by BMI and ethnicity: a matched case–control analysis. Cardiovasc Diabetol 17(1):70. https://doi.org/10.1186/s12933-018-0712-1 CrossRefPubMedPubMedCentralGoogle Scholar