Open AccessImpaired Fasting Glucose and Body Mass Index as Determinants of Mortality in ALLHAT : Is the Obesity Paradox Real?
Author(s) -
Shah Ravi V.,
Abbasi Siddique A.,
Yamal JoséMiguel,
Davis Barry R.,
Barzilay Joshua,
Einhorn Paula T.,
Goldfine Allison
Publication year - 2014
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12325
Subject(s) - medicine , underweight , body mass index , hazard ratio , obesity , impaired fasting glucose , obesity paradox , diabetes mellitus , confounding , confidence interval , population , endocrinology , impaired glucose tolerance , overweight , insulin resistance , environmental health
Emerging literature suggests that obesity may be “protective” against mortality and cardiovascular outcomes, while dysglycemia may worsen outcomes regardless of obesity. The authors measured the association of weight, smoking, and glycemia with mortality in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ). Among 5423 ALLHAT participants without established diabetes or cardiovascular disease, 3980 (73%) had normal fasting glucose and 1443 (27%) had impaired fasting glucose ( IFG ) levels at study entry. After a median of 4.9 years follow‐up, 554 (10%) had died (37% cardiovascular). IFG was associated with higher all‐cause mortality (adjusted hazard ratio [HR], 1.23; 95% confidence interval [ CI], 1.02–1.50), while obesity was associated with lower all‐cause mortality (adjusted HR, 0.76; 95% CI, 0.60–0.96). However, after excluding underweight individuals (body mass index [ BMI] <22 kg/m 2 ) and smokers, neither obesity nor IFG was associated with all‐cause mortality, but IFG identifies individuals at greater risk in the nonobese population. Although obesity appeared protective against mortality, this association was not significant in never‐smokers or after exclusion of BMI <22 kg/m 2 . The obesity paradox may result from confounding by a sicker, underweight referent population and smoking.