Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study

Ling Yao; Mulalibieke Heizhati; Mengyue Lin; Lin Gan; Xiaoguang Yao; Yingchun Wang; Qing Zhu; Lin Wang; Yujuan Yuan; Mei Li; Wenbo Yang; Nanfang Li

doi:10.1016/j.orcp.2022.10.010

Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study

Obes Res Clin Pract. 2022 Nov-Dec;16(6):491-499. doi: 10.1016/j.orcp.2022.10.010. Epub 2022 Nov 24.

Authors

Affiliations

¹ Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China.
² Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China. Electronic address: lnanfang2016@sina.com.

PMID: 36437224
DOI: 10.1016/j.orcp.2022.10.010

Abstract

Background: Effects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA).

Methods: Hypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age.

Results: 2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m²), 1164 overweight (25-29.9 kg/m²) and 670 obesity (≥30 kg/m²). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01-2.32, P = 0.047) and obesity groups (1.85, 1.19-2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04-2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030).

Conclusions: BMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.

Keywords: Body mass index; Cardiovascular events; Hypertension; Non-fatal cardiovascular events; Obstructive sleep apnea.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cohort Studies
Humans
Obesity / complications
Overweight / complications
Sleep Apnea, Obstructive* / complications