Mixed
In individuals with ideal cardiovascular health (high CVHS), elevated BMI (≥35.0 kg/m²) does not significantly increase the risk of incident atherosclerotic cardiovascular disease (ASCVD) compared to normal BMI, whereas low cardiovascular health strongly predicts ASCVD regardless of BMI.
If you have ideal cardiovascular health (normal blood pressure, lipids, glucose, no smoking, active, healthy diet, good sleep), your risk of heart disease is low even if your BMI is high (≥35). Focus on maintaining these healthy habits rather than trying to lose weight. If your cardiovascular health score is low, your risk is high regardless of your BMI, so prioritize improving lifestyle and metabolic markers.
In participants with a high CVHS (8-10), those with a BMI ≥35.0 kg/m2 had a nonsignificant higher ASCVD risk (HR=1.20 [95% CI, 0.84-1.70], p=0.32) compared to those with a BMI of 18.5-24.9 kg/m2.
Why this rating
Large prospective cohort (n=319,866) with long follow-up (median 12.5 years), though observational design limits causal inference.
Source
Sex‐Specific Impact of Body Weight on Atherosclerotic Cardiovascular Disease Incidence in Individuals With and Without Ideal Cardiovascular Health
Audrey Paulin et al. · Journal of the American Heart Association · 2023
DOI 10.1161/jaha.122.028502
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