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The relationship between diabetes, obesity and cardiovascular disease phenotypes: a UK Biobank cohort study

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posted on 2023-06-27, 18:34 authored by Oliver I Brown, Michael Drozd, Hugo McGowan, Marilena Giannoudi, Marcella Conning-Rowland, John Gierula, Sam Straw, Stephen B Wheatcroft, Katherine Bridge, Lee D Roberts, Eylem Levelt, Ramzi Ajjan, Kathryn J Griffin, Marc A Bailey, Mark T Kearney, Richard M Cubbon

Objective

Obesity and diabetes frequently co-exist, yet their individual contributions to cardiovascular risk remain debated. We explored cardiovascular disease biomarkers, events and mortality in UK Biobank stratified by body mass index (BMI) and diabetes.

Research design and Methods

451,355 participants were stratified by ethnicity-specific BMI categories (normal, overweight, obese) and diabetes status. We examined cardiovascular biomarkers including: carotid intima-media thickness (CIMT); arterial stiffness; left ventricular ejection fraction (LVEF) and cardiac contractility index (CCI). Poisson regression models estimated adjusted incidence rate ratios (IRR) for myocardial infarction, ischemic stroke and cardiovascular death, with normal weight non-diabetes as comparator.

Results

5% of participants had diabetes (10% normal weight, 34% overweight and 55% obese; versus 34%, 43% and 23%, respectively, in non-diabetes). In the non-diabetes group, overweight/obesity was associated with higher CIMT, arterial stiffness and CCI, and lower LVEF (p<0.005); these relationships were diminished in the diabetes group. Within BMI classes, diabetes was associated with adverse cardiovascular biomarker phenotype (p<0.005), particularly in the normal weight group. After 5,323,190 person-years follow-up, incident myocardial infarction, ischemic stroke and cardiovascular mortality rose across increasing BMI categories without diabetes (p<0.005); this was comparable in the diabetes groups (p-interaction>0.05). Normal weight diabetes had comparable adjusted cardiovascular mortality to obese non-diabetes (IRR 1.22 [95% confidence interval: 0.96-1.56]; p=0.1).

Interpretation

Obesity and diabetes are additively associated with adverse cardiovascular biomarkers and mortality risk. Whilst adiposity metrics are more strongly correlated with cardiovascular biomarkers than diabetes-oriented metrics, both correlate weakly, suggesting other factors underpin the high cardiovascular risk of normal-weight diabetes.