Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk
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.
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