THE RELATIONSHIP BETWEEN BODY MASS INDEX (BMI) AND CARDIOVASCULAR DISEASE RISK: A META-ANALYSIS
Main Article Content
Keywords
Body mass index; Obesity; Cardiovascular disease; Meta-analysis; Cohort studies
Abstract
High body mass index (BMI) has been established as a risk factor of cardiovascular disease (CVD), but there is still uncertainty about the degree of risk in relation to BMI categories, continuous BMI and pattern of change. These associations must be elucidated by a thorough synthesis of current prospective evidence. A meta-analysis and systematic review were performed in accordance with the PRISMA 2020 guidelines. Every major database was investigated to find possible cohort studies that may analyse the relationship between BMI and cardiovascular outcomes in adults. Similar BMI-CVD associations were carried out by random-effects meta-analyses when pooling of the studies was not possible, and descriptive synthesis was applied. The I2 statistic was used to test heterogeneity, and the funnel plot was used to test publication bias. Ten potential cohort studies with various populations were incorporated. Obesity was linked to a much higher risk of cardiovascular disease compared to normal BMI; overweight status was linked to a smaller and more heterogeneous association. The sustained BMI measurements showed that there was a positive linear correlation existing between rising BMI and the occurrence of myocardial infarction, stroke, coronary heart disease, and CVD mortality. Longitudinal studies showed that the significant BMI gain with time was linked to significantly high cardiovascular mortality, and significant unintentional BMI losses were correlated with increased risk. Subgroup and sensitivity analyses proved the validity of results in terms of sex, age, geographical area, and quality of the study. Funnel plot analysis indicated the potential small-study effects but could not be interpreted due to heterogeneity. High BMI is uniformly correlated with high risks of cardiovascular disease and obesity carries a significantly higher risk than overweight. Growth in BMI and negative BMI trends only worsen cardiovascular risk. These results highlight the significance of the prevention of obesity in early years of life, management of weight throughout life, and extensive evaluation of cardiovascular risks.
References
2. Bundy, J. D., Ning, H., Zhong, V. W., Paluch, A. E., Lloyd-Jones, D. M., Wilkins, J. T., & Allen, N. B. (2020). Cardiovascular health score and lifetime risk of cardiovascular disease: the cardiovascular lifetime risk pooling project. Circulation: Cardiovascular Quality and Outcomes, 13(7), e006450.
3. Chen, G., & Levy, D. (2016). Contributions of the framingham heart study to the epidemiology of coronary heart disease. JAMA cardiology, 1(7), 825.
4. Chen, Y., Yu, W., Lv, J., Sun, D., Pei, P., Du, H., ... & Yu, C. (2024). Early adulthood BMI and cardiovascular disease: a prospective cohort study from the China Kadoorie Biobank. The Lancet Public Health, 9(12), e1005-e1013.
5. Cheng, Y., Wu, S., Chen, S., & Wu, Y. (2025). Association of body mass index combined with triglyceride-glucose index in cardiovascular disease risk: a prospective cohort study. Scientific Reports, 15(1), 17687.
6. Dörr, M. (2025). Big data and cardiovascular risk—insights into obesity, diabetes, and coronary heart disease. Herz, 1-8.
7. Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2018). Excess Deaths Associated With Underweight, Overweight, and Obesity: An Evaluation of Potential Bias. Vital & Health Statistics. Series 3, Analytical and Epidemiological Studies, (42), 1-21.
8. Gill, D., Zuber, V., Dawson, J., Pearson-Stuttard, J., Carter, A. R., Sanderson, E., ... & Elliott, P. (2021). Risk factors mediating the effect of body mass index and waist-to-hip ratio on cardiovascular outcomes: Mendelian randomization analysis. International Journal of Obesity, 45(7), 1428-1438.
9. Gunning, M. N., Meun, C., Van Rijn, B. B., Daan, N. M., Roeters van Lennep, J. E., Appelman, Y., ... & CREW consortium. (2020). The cardiovascular risk profile of middle age women previously diagnosed with premature ovarian insufficiency: A case-control study. PloS one, 15(3), e0229576.
10. Haidar, A., Kronmal, R., Allison, M., Watson, K., Srikanthan, P., & Horwich, T. (2025). Examining the relationship between anthropometric and body composition measures with coronary heart disease events: the multi-ethnic study of atherosclerosis. European Journal of Preventive Cardiology, zwaf212.
11. Haidar, A., Kronmal, R., Allison, M., Watson, K., Srikanthan, P., & Horwich, T. (2025). Fat mass, fat-free mass, and cardiovascular risk: Insights from body composition measures in the Multi-Ethnic Study of Atherosclerosis. European Journal of Preventive Cardiology.
12. Han, M., Qie, R., Shi, X., Yang, Y., Lu, J., Hu, F., ... & Zhao, Y. (2022). Cardiorespiratory fitness and mortality from all causes, cardiovascular disease and cancer: dose–response meta-analysis of cohort studies. British journal of sports medicine, 56(13), 733-739.
13. Held, C., Hadziosmanovic, N., Aylward, P. E., Hagström, E., Hochman, J. S., Stewart, R. A., ... & Wallentin, L. (2022). Body mass index and association with cardiovascular outcomes in patients with stable coronary heart disease–a STABILITY substudy. Journal of the American Heart Association, 11(3), e023667.
14. Iyen, B., Weng, S., Vinogradova, Y., Akyea, R. K., Qureshi, N., & Kai, J. (2021). Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK. BMC Public Health, 21(1), 576.
15. Jakicic, J. M., Rogers, R. J., Davis, K. K., & Collins, K. A. (2018). Role of physical activity and exercise in treating patients with overweight and obesity. Clinical chemistry, 64(1), 99-107.
16. Karra, P., Hardikar, S., Winn, M., Anderson, G. L., Haaland, B., Shadyab, A. H., ... & Playdon, M. C. (2025). Metabolic Phenotype and Risk of Obesity-Related Cancers in the Women’s Health Initiative. Cancer Prevention Research, 18(2), 63-72.
17. Khan, S. S., Ning, H., Wilkins, J. T., Allen, N., Carnethon, M., Berry, J. D., ... & Lloyd-Jones, D. M. (2018). Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA cardiology, 3(4), 280-287.
18. Kim, D., Kim, H. J., & Song, T. J. (2024). Association of body composition indices with cardiovascular outcomes: a nationwide cohort study. The American Journal of Clinical Nutrition, 119(4), 876-884.
19. Koskinas, K. C., Van Craenenbroeck, E. M., Antoniades, C., Blueher, M., Gorter, T. M., Hanssen, H., ... & Prescott, E. B. (2024). Obesity and cardiovascular disease: an ESC clinical consensus statement. European heart journal, 45(38), 4063-4098.
20. Lai, Y. J., Yen, Y. F., Chen, L. J., Hsu, L. F., Ahmadi, M. N., Inan-Eroglu, E., ... & Stamatakis, E. (2025). Modification of risk for all-cause and cardiovascular disease-related mortality with changes in the body mass index: a prospective cohort study with 12 years follow up. BMC Public Health, 25(1), 1-12.
21. Lee, T. L., Lin, F. J., Yeh, C. F., Hsiao, Y. C., Yang, K. C., Hsuan, C. F., & Wu, C. C. (2025). Evaluating the potential of waist-to-BMI ratio, a body shape index, and other anthropometric parameters in predicting cardiovascular disease mortality: evidence from NHANES III. BMC Public Health, 25(1), 1828.
22. Lopez-Jimenez, F., Almahmeed, W., Bays, H., Cuevas, A., Di Angelantonio, E., le Roux, C. W., ... & Wilding, J. P. (2022). Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. European journal of preventive cardiology, 29(17), 2218-2237.
23. Lumish, H. S., O’Reilly, M., & Reilly, M. P. (2020). Sex differences in genomic drivers of adipose distribution and related cardiometabolic disorders: opportunities for precision medicine. Arteriosclerosis, thrombosis, and vascular biology, 40(1), 45-60.
24. Manson, J. E., Colditz, G. A., Stampfer, M. J., Willett, W. C., Rosner, B., Monson, R. R., ... & Hennekens, C. H. (1990). A prospective study of obesity and risk of coronary heart disease in women. New England journal of medicine, 322(13), 882-889.
25. Mehran, L., Honarvar, M., Masoumi, S., Khalili, D., Azizi, F., Blaha, M. J., & Amouzegar, A. (2024). The association of body mass index variability with cardiovascular disease and mortality: a mediation analysis of pooled cohorts. Frontiers in Endocrinology, 15, 1345781.
26. Mehta, L. S., Velarde, G. P., Lewey, J., Sharma, G., Bond, R. M., Navas-Acien, A., ... & Mieres, J. H. (2023). Cardiovascular disease risk factors in women: the impact of race and ethnicity: a scientific statement from the American Heart Association. Circulation, 147(19), 1471-1487.
27. O'Donnell, M. J., Chin, S. L., Rangarajan, S., Xavier, D., Liu, L., Zhang, H., ... & Yusuf, S. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. The lancet, 388(10046), 761-775.
28. Ortega, F. B., Lavie, C. J., & Blair, S. N. (2016). Obesity and cardiovascular disease. Circulation research, 118(11), 1752-1770.
29. Owen, C. G., Kapetanakis, V. V., Rudnicka, A. R., Wathern, A. K., Lennon, L., Papacosta, O., ... & Whincup, P. H. (2015). Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study. BMJ open, 5(9), e008105.
30. Preda, A., Carbone, F., Tirandi, A., Montecucco, F., & Liberale, L. (2023). Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management. Reviews in Endocrine and Metabolic Disorders, 24(5), 901-919.
31. Schmid, D., & Leitzmann, M. F. (2015). Cardiorespiratory fitness as predictor of cancer mortality: a systematic review and meta-analysis. Annals of oncology, 26(2), 272-278.
32. Shah, S. A. H., Khan, H. R., Afghan, T. S., Ahmed, N., Saeed, A., Ullah, M. N., ... & Bibi, M. (2025). Investigating the Role of Physical Activity and Exercise in Preventing Obesity and Type 2 Diabetes: A Mixed-Methods Approach. Indus Journal of Bioscience Research, 3(2), 525-533.
33. Vaduganathan, M., Mensah, G. A., Turco, J. V., Fuster, V., & Roth, G. A. (2022). The global burden of cardiovascular diseases and risk: a compass for future health. Journal of the American College of Cardiology, 80(25), 2361-2371.
34. Wang, Y., Zhao, L., Gao, L., Pan, A., & Xue, H. (2021). Health policy and public health implications of obesity in China. The lancet Diabetes & endocrinology, 9(7), 446-461.
35. Weeldreyer, N. R., De Guzman, J. C., Paterson, C., Allen, J. D., Gaesser, G. A., & Angadi, S. S. (2025). Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis. British journal of sports medicine, 59(5), 339-346.
36. Wu, C., Li, Y., Li, N., Chan, K. K., & Piao, C. (2025). Body Mass Index and Risk of All-Cause and Cardiovascular Disease Mortality in Patients With Type 2 Diabetes Mellitus. Endocrinology, 166(4), bqaf040.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Sudeep Saran
Director, Physician and Diabetologist, Saran hospital and institute of Paramedical Sciences Bareilly
