Author + information
- Received June 29, 2015
- Revision received July 20, 2015
- Accepted July 30, 2015
- Published online December 1, 2015.
- Stephanie E. Chiuve, ScD∗,†,‡∗ (, )
- Qi Sun, MD, ScD§,‡,
- Roopinder K. Sandhu, MD, MPH†,‖,
- Usha Tedrow, MD, MSc∗,¶,
- Nancy R. Cook, ScD†,#,
- JoAnn E. Manson, MD, DrPH†,#,
- Kathryn M. Rexrode, MD, MPH† and
- Christine M. Albert, MD, MPH∗,†,¶
- ∗Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- †Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- ‡Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- §The Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- ‖Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
- ¶Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- #Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Stephanie E. Chiuve, Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Avenue, Boston, Massachusetts 02215.
Objectives This study examined the association of BMI repeatedly measured over 32 years and BMI during early and mid-adulthood with risk of sudden cardiac death (SCD) in the Nurses’ Health Study.
Background SCD is often the first manifestation of coronary heart disease among women. Data regarding body mass index (BMI) and risk of SCD are limited and conflicting.
Methods We prospectively followed 72,484 women free of chronic disease from 1980 to 2012. We ascertained adult height, current weight, and weight at age 18 years at baseline, and updated weight biennially. The primary endpoint was SCD (n = 445).
Results When updated biennially, higher BMI was associated with greater SCD risk after adjusting for confounders (p linear trend <0.001). Compared with a BMI of 21.0 to 22.9 kg/m2, the multivariate relative risk (RR) of SCD was 1.46 (95% confidence interval [CI]: 1.05 to 2.04) for BMI 25.0 to 29.9 kg/m2, 1.46 (95% CI: 1.00 to 2.13) for BMI 30.0 to 34.9 kg/m2, and 2.18 (95% CI: 1.44 to 3.28) for BMI ≥35.0 kg/m2. Among women with a BMI ≥35.0 kg/m2, SCD remained elevated even after adjustment for interim development of coronary heart disease and other mediators (RR: 1.72; 95% CI: 1.13 to 2.60). In contrast, the association between BMI and fatal coronary heart disease risk was completely attenuated after adjustment for mediators. The magnitude of the association between BMI and SCD was greater when BMI was assessed at baseline or at age 18 years, at which time SCD risk remained significantly elevated at BMI ≥30 kg/m2 after adjustment for mediators.
Conclusions Higher BMI was associated with greater risk of SCD, particularly when assessed earlier in adulthood. Strategies to maintain a healthy weight throughout adulthood may minimize SCD incidence.
This study was funded by CA87969, HL034594, HL097068 (Dr. Chiuve), and HL098459 (Dr. Sun) from the National Institutes of Health and an Established Investigator Award from the American Heart Association (Dr. Albert). Dr. Chiuve is supported in part by a Watkins Discovery Award from Brigham and Women’s Hospital. Dr. Tedrow has received minor range fellows course honoraria from St. Jude Medical; and minor range faculty honoraria from Biosense Webster. Dr. Albert has received grant support from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 29, 2015.
- Revision received July 20, 2015.
- Accepted July 30, 2015.
- American College of Cardiology Foundation