Reducing the Population Burden of Coronary Heart Disease by Modifying Adiposity: Estimates From the ARIC Study

Background: Excess adiposity, which affects 69% of US adults, increases coronary heart disease (CHD) risk in an association that manifests below conventional obesity cut points. The population-level impact on CHD risk that is attainable through modest adiposity reductions in populations is not well characterized. We estimated the effect of hypothetical reductions in both body mass index (BMI) and waist circumference (WC) on CHD incidence. Methods and Results: The study population included 13 610 ARIC (Atherosclerosis Risk in Communities) participants. Our hypothetical reduction in BMI or WC was applied relative to the temporal trend, with no hypothetical reduction among those with BMI >24 or WC >88 cm, respectively. This threshold for hypothetical reduction is near the clinical guidelines for excess adiposity. CHD risk differences compared the hypothetical reduction with no reduction. Sensitivity analysis was conducted to estimate the effect of applying the hypothetical BMI reduction at the established overweight cut point of 25. Cumulative 12-year CHD incidence with no intervention was 6.3% (95% CI, 5.9–6.8%). Risk differences following the hypothetical BMI and WC reductions were −0.6% (95% CI, −1.0% to −0.1%) and −1.0% (95% CI, −1.4% to −0.5%), respectively. These results were robust for the sensitivity analyses. Consequently, we estimated that this hypothetical reduction of 5% in BMI and WC, respectively, could have prevented 9% and 16%, respectively, of the CHD events occurring in this study population over 12 years, after adjustment for established CHD risk factors. Conclusions: Meaningful CHD risk reductions could derive from modest reductions in adiposity attainable through lifestyle modification

Body fat responses to a 1-year combined exercise training program in male coronary artery disease patients

Objective: To analyze the body fat (BF) content and distribution modifications in coronary artery disease (CAD) patients in response to a 1-year combined aerobic and resistance exercise training (CET) program. Design and Methods: We followed two groups of CAD male patients for 12 months. One group consisted of 17 subjects (57 6 12 years) who engaged in a CET program (CET group) and the other was a age-matched control group of 10 subjects (58 6 11 years). BF content and distribution were measured through dual energy X-ray absorptiometry (DXA) at baseline and follow-up. Results: We found no differences on body mass and BMI between baseline and end of follow-up in both groups but, in CET group, we found significant reductions in all analyzed BF depots, including total BF (21.60 6 6.00 vs. 20.32 6 5.89 kg, P < 0.01), % total BF (27.8 6 5.5 vs. 26.4 6 5.4%, P < 0.05), trunk fat (12.54 6 3.99 vs. 11.77 6 4.01 kg, P < 0.05), % trunk fat (31.1 6 6.9 and 29.2 6 7.1%, P < 0.05), appendicular fat (8.22 6 2.08 vs. 7.72 6 2.037 kg, P < 0.01), % appendicular fat (25.7 6 4.9 and 24.5 6 4.9%, P < 0.05), and abdominal fat (2.95 6 1.06 vs. 2.75 6 1.10 kg, P < 0.05). Control group showed significant increase in appendicular fat (7.63 6 1.92 vs. 8.10 6 2.12 kg, P < 0.05). Conclusions: These results confirm the positive effect of CET on body composition of CAD patients, despite no changes in body mass or BMI. In this study, we observed no alterations on BF distribution meaning similar rate of fat loss in all analyzed BF depots. These results also alert for the limitations of BMI for tracking body composition changes.info:eu-repo/semantics/publishedVersio