Evidence map›Paper›PMID 25960160›Full record

SynthesisThe lancet. Diabetes & endocrinology2015

The sex-specific association between BMI and coronary heart disease: a systematic review and meta-analysis of 95 cohorts with 1·2 million participants.

Morgana L Mongraw-Chaffin, Sanne A E Peters, Rachel R Huxley, Mark Woodward

Open access · greenAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The lancet. Diabetes & endocrinology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 107 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
107citing papers in PubMed, 9 pooled it
9.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

107 citing papers in PubMed, 9 syntheses or guidelines pooled it, 200 citations in OpenAlex.

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  7. Management of overweight and obesity in primary care-A systematic overview of international evidence-based guidelines.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2019
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47 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 4 institutions in 4 countries.

Morgana L Mongraw-ChaffinDepartment of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA. Electronic address: mmongrawchaffin@ucsd.edu.
Sanne A E PetersThe George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Rachel R HuxleySchool of Public Health, University of Queensland, Brisbane, QLD, Australia.
Mark WoodwardThe George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
George Institute for Global Health · GBJohns Hopkins University · USUniversity of California, San Diego · USUniversity of Queensland · AU

Funding

UCSD Integrated Cardiovascular Epidemiology FellowshipT32HL079891 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Matthew A Allison · 2007 to 2026
$6.7M
NHLBI NIH HHS HHSN268201100005CNHLBI NIH HHS HHSN268201100005GNHLBI NIH HHS HHSN268201100005INHLBI NIH HHS HHSN268201100006CNHLBI NIH HHS HHSN268201100007CNHLBI NIH HHS HHSN268201100007INHLBI NIH HHS HHSN268201100008CNHLBI NIH HHS HHSN268201100008INHLBI NIH HHS HHSN268201100009CNHLBI NIH HHS HHSN268201100009INHLBI NIH HHS HHSN268201100010CNHLBI NIH HHS HHSN268201100011CNHLBI NIH HHS HHSN268201100011INHLBI NIH HHS HHSN268201100012CNHLBI NIH HHS T32 HL079891NHLBI NIH HHS T32HL079891
6 · The paper itself

Abstract

backgroundThe risk of developing coronary heart disease differs by sex, and accumulating evidence suggests that sex differences exist in the effect of coronary risk factors on vascular risk. So far, the existence of a sex difference in the association between BMI and coronary heart disease has not been systematically studied. Since sexual dimorphisms in body composition exist, we postulated that the association between BMI and coronary heart disease would differ between women and men.

methodsWe did systematic searches of PubMed and Embase up to Feb 20, 2015, for studies of the longitudinal association between BMI and coronary heart disease in women and men from population-based cohorts. We excluded studies if they contained duplicate data from the same study, reported estimates only for Z scores or percentiles of BMI, did not report estimate uncertainty, did not report sex-specific estimates, recruited mainly individuals with a previous history of cardiovascular disease or from within selected populations, and those for which the full text was not available in English. We also included individual participant data from four large studies. Study results were pooled using random-effect models with inverse variance weighting. Our predefined primary endpoint was the pooled women-to-men ratio of the age-adjusted hazard ratios (HRs), or equivalent, relating (continuous and categorical) BMI to coronary heart disease.

findingsWe reviewed a total of 8561 original entries twice for inclusion in the analysis, of which 32 published studies were eligible for inclusion. Data from 95 cohorts, 1,219,187 participants, and 37,488 incident cases of coronary heart disease were included. Higher BMI was significantly associated with age-adjusted coronary heart disease: for a one-unit (kg/m(2)) increment in BMI; the HR was 1·04 (95% CI 1·03-1·05) in women and 1·05 (1·04-1·07) in men. Compared with people of a normal weight, the age-adjusted HR of coronary heart disease for the underweight group was 1·25 (1·05-1·49) in women and 1·09 (0·91-1·23) in men; for the overweight group 1·20 (1·12-1·29) in women and 1·22 (1·12-1·32) in men; and for the obese group 1·61 (1·42-1·82) in women and 1·60 (1·43-1·79) in men. Overall, these associations did not differ between the sexes. The women-to-men ratios of the HRs were 0·99 (95% CI 0·98-1·00) for a one-unit increment in BMI, 1·10 (0·91-1·32) for the underweight group, 0·99 (0·92-1·07) for the overweight group, and 1·06 (0·95-1·17) for the obese group, relative to the normal weight group. Similar results were obtained after multiple adjustment and in a range of sensitivity analyses.

interpretationIncreased BMI, measured either continuously or categorically, has the same deleterious effects on the risk of coronary heart disease in women and men across diverse populations.

fundingNone.

Indexed as

Body Mass IndexSex FactorsAdultAgedAged, 80 and overBody CompositionCohort StudiesCoronary DiseaseFemaleHumansLongitudinal StudiesMaleMiddle AgedObesityPrevalenceRisk Factors

Identifiers

PMID25960160
PMCPMC4470268
OpenAlexW2142165959

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.