Current adolescent obesity trend will lead to more CHD

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Dec. 6 – The current trend of adolescent obesity will increase rates of coronary heart disease (CHD) among future young and middle-aged adults, resulting in substantial morbidity and mortality, according to a study published in the Dec. 6 issue of The New England Journal of Medicine (NEJM).

Kirsten Bibbins-Domingo, PhD, MD, of the departments of medicine, epidemiology and biostatistics and pharmacy at the University of California at San Francisco, and colleagues, estimated the prevalence of obese 35 year olds in 2020 on the basis of adolescent overweight in 2000. The researchers also noted the historical trends regarding overweight adolescents who become obese adults. Then, they used the CHD policy model, a state-transition computer simulation of U.S. residents who are 35 years of age or older, to project the annual excess incidence and prevalence of CHD, the total number of excess CHD events, and excess deaths from both CHD and other causes attributable to obesity from 2020 to 2035. The researchers also modeled the effect of treating obesity-related increases in blood pressure and dyslipidemia.

The researchers found that the prevalence of adolescents overweight in 2000 was 16.7 percent in boys and 15.4 percent in girls. By the time the adolescents turn 35 in 2020, the proportion of obese 35 year olds is projected to be 30 to 37 percent in men, compared with 25 percent now; and 34 to 44 percent in women, compared with 32 percent now.

The higher predicted prevalence of obesity among future 35 year olds is projected to increase the rates of annual CHD events and events not associated with CHD, with the absolute number of excess events rising with each year from 2020 to 2035.

The steepest rise is projected in the total number of CHD events, with 550 absolute excess events in 2020 (10 percent) increasing to 33,000 excess events in 2035 (14 percent). On the basis of historical trends, the researchers predicted that low projections call for 250 excess CHD events in 2020 (4 percent) increasing to 14,000 in 2035 (6 percent); high projections call for 770 excess events in 2020 (13 percent) increasing to 45,000 in 2035 (19 percent).

The number of excess deaths from CHD is projected to rise from 59 in 2020 (9 percent) to 3,600 in 2035 (13 percent). Low projections expect an increase in CHD deaths from 26 in 2020 (4 percent) to 1,500 in 2035 (6 percent); high projections call for an increase in the number of CHD deaths from 84 in 2020 (13 percent) to 5,000 in 2035 (19 percent).

Deaths that are associated with obesity but not with CHD are projected to increase by 4 percent each year, with the absolute number rising from an excess of 250 in 2020 to 6,200 in 2035.

The researchers acknowledged that “projections 25 or more years into the future are notoriously unreliable because many factors that are important to the projection may change in the interim.” However, “on the basis of current treatments, data, and trends, we project that the current epidemic of adolescent overweight will substantially increase future rates of adult CHD unless other changes intervene,” the researchers said.