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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
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Authors Affiliations
  1. 1. Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Prevention of Cardiovascular Disease Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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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