Obesity in older adults and life expectancy with and without cardiovascular disease

BACKGROUND: The prevalence of overweight and obesity is increasing globally and is an established risk factor for cardiovascular disease (CVD). Our objective was to evaluate the impact of overweight and obesity on life expectancy and years lived with and without CVD in older adults. METHODS: The study included 6636 individuals (3750 women) aged 55 years and older from the population-based Rotterdam Study. We developed multistate life tables by using prevalence, incidence rate and hazard ratios (HR) for three transitions (free-of-CVD-to-CVD, free-of-CVD-to-death and CVD-to-death), stratifying by the categories of body mass index (BMI) at baseline and adjusting for confounders. RESULTS: During 12 years of follow-up, we observed 1035 incident CVD events and 1902 overall deaths. Obesity was associated with an increased risk of CVD among men (HR 1.57 (95% confidence interval (CI) 1.17, 2.11)) and women (HR 1.49 (95% CI 1.19, 1.86)), compared with normal weight individuals. Overweight and obesity were not associated with mortality in men and women without CVD. Among men with CVD, obesity compared with normal weight, was associated with a lower risk of mortality (HR 0.67 (95% CI 0.49, 0.90)). Overweight and obesity did not influence total life expectancy. However, obesity was associated with 2.6 fewer years (95% CI -4.8, -0.4) lived free from CVD in men and 1.9 (95% CI -3.3, -0.9) in women. Moreover, men and women with obesity lived 2.9 (95% CI 1.1, 4.8) and 1.7 (95% CI 0.6, 2.8) more years suffering from CVD compared with normal weight counterparts. CONCLUSIONS: Obesity had no effect on total life expectancy in older individuals, but increased the risk of having CVD earlier in life and consequently extended the number of years lived with CVD. Owing to increasing prevalence of obesity and improved treatment of CVD, we might expect more individuals living with CVD and for a longer period of time.