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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 Publisher Pubmed



Mozafar Saadati H1 ; Sabour S1 ; Mansournia MA2 ; Mehrabi Y1 ; Hashemi Nazari SS3
Authors

Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews Published:2021


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. © 2021
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