Evaluating population attributable fractions of cardiovascular diseases in relation to 20-year body mass index; the ATTICA study (2002-2022).

BACKGROUND/OBJECTIVES: The growing prevalence of overweight and obesity globally highlights the need to reconsider the thresholds for defining excess body weight, especially as the health risks associated with weight gain continue to impact population health metrics. This study aimed to evaluate the population attributable fraction (PAF) and prevented fraction for the population (PFP) of CVD cases by body weight trajectories over a 20-year period (2002-2022).

SUBJECTS/METHODS: The studied population-based sample was 1348 individuals (39(10) years old, 48% males), initially free-of-CVD, from the ATTICA cohort study (2002-2022). Combined fatal/non-fatal CVD outcomes were evaluated; body weight and height measurements were performed in 2002, 2012, and 2022 examinations, following standard procedures. Body weight trends, based on cumulative average BMI during 2002-2022, were also calculated. PAF and PFP were computed.

RESULTS

Twenty-nine percent (95%Confidence Interval: 22%, 35%) of CVD cases were prevented by maintaining a normal body weight status during 2002-2022. If increased BMI (>25 kg/m) had been eliminated, 30% (8.7%, 38%) of CVD cases would have been prevented. Three-times more CVD cases would have been prevented if overweight had been managed compared to if obesity had been managed [i.e., 23% (5.1%, 29%) vs 7.2% (1.1%, 9.1%), respectively]. Variations of the PAFs and PFPs were observed by sex, age group, Mediterranean diet adherence, physical activity status, presence of comorbidities, and anxiety trajectories.

CONCLUSIONS

Future public health actions should not neglect to also include people with overweight for the effective management of body weight, which can offer significant long-term benefits for cardiovascular health. A graphical representation of the main study findings on population prevented and attributable fractions by long-term body weight status (n = 1348); the ATTICA study (2002-2022). CVD cardiovascular disease.