Association of abdominal obesity with the development of fatal and non-fatal cardiovascular events in a cohort of rural residents of the Kyrgyz Republic: gender and ethnic characteristics

Objective. To study the relationship of abdominal obesity (AO) with the development of fatal and non-fatal cardiovascular events among residents of the Chui region of the Kyrgyz Republic, taking into account gender and ethnicity.

Design and methods. This study was carried out as part of the international epidemiological study “Interepid”. The total follow-up period was 7 years. Life status at the end of the follow-up was monitored in 1096 respondents out of 1341 initial cohorts (response 82,1%). Cases of fatal and non-fatal cardiovascular events were included as endpoints in the analysis. The frequency of events was assessed using methods of analysis of survival (Cox proportional hazard regression model, parametric survival models, Kaplan–Meier survival analysis).

Results. 181 cases of fatal and non-fatal cardiovascular events (16,44%) were registered during the follow-up. A significant effect of AO on the incidence of cardiac complications in the analyzed cohort was demonstrated. Thus, in respondents with AO, the total frequency of cardiovascular events reached 21,31% and was significantly higher than in those without AO (10,69%, p < 0,0001). An increase in the frequency of events in the presence of AO was recorded in all analyzed subgroups (men, women, Russians, Kyrgyz). The construction of a Cox regression model with a logistic regression analysis made it possible to confirm the independent role of AO in the development of fatal and non-fatal cardiovascular events, which was most pronounced in women and respondents of the Kyrgyz ethnic group. At the same time, on average for the cohort, an increase in waist circumference value by 1 cm is accompanied by an increase in cardiovascular risk by 1,9%.

Conclusions. The presence of AO is an independent risk factor for the development of fatal and non-fatal cardiovascular events in the analyzed cohort of residents of the Chui region, mostly among women and respondents of the Kyrgyz ethnic group.

1. Souza SA, Silva AB, Cavalcante UMB, Lima CMBL, de Souza TC. Adult obesity in different countries: an analysis via beta regression models. Cad Saude Publica. 2018;34(8):e00161417. doi:10.1590/0102-311X00161417

2. Katz D, Friedman R. Diet, weight regulation, and obesity. In: Nutrition in clinical practice. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. P. 43–101.

3. Kaplan NM. The deadly quartet: Upper-body obesity, glucose intobrance, hypertrygliceridemia and hypertension. Arch Intern Med. 1989;149(7):1514–1520.

4. Rosengren A, Scoog I, Gustafson D, Wilhelmsen L. Body mass index, other cardiovascular risk factors and hospitalization for dementia. Arch Intern Med. 2005;165(3):320–325.

5. Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M et al. Visceral adiposity index a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920–922. doi:10.2337/dc09-1825

6. Romantsova TI, Ostrovskaya EV. Metabolically healthy obesity: definitions, protective factors, clinical relevance. Almanakh Klinicheskoi Meditsiny = Almanac of Clinical Medicine. 2015;1(1):75–86. doi:10.18786/2072-0505-2015-1-75-86. In Russian.

7. Titov VN, Dmitriev VA. Obesity is a pathology of adipocytes: cell number, arterial bed volume, local circulation pools in vivo, natriuretic peptides and arterial hypertension. Translyatsionnaya Meditsina = Translational Medicine. 2015;1:26–38. In Russian.

8. Rakel D. Integrative Medicine. E-Book. Elsevier Health Sciences; 2017.

9. Barry V, Baruth M, Beets M, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis. 2014;56(4):382–390. doi:10.1016/j.pcad.2013.09.002

10. Hansel B, Roussel R, Elbez Y, Marre M, Krempf M, Ikeda Y et al. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. Eur Heart J. 2015;36(40):2716–2728. doi:10.1093/eurheartj/ehv347

11. Dzhumagulova AS, Polupanov AG, Khalmatov AN. Gender and ethnic characteristics of the prevalence of obesity among residents of small towns and rural areas of the Kyrgyz Republic (according to the Interepid Study). Kardiologicheskij Vestnik = Cardiological Bulletin. 2019;2:61–6. In Russian.

12. The Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual participant-data metaanalysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776–786. doi:10.1016/S0140-6736(16)30175-1

13. Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S et al. BMI and all-cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3,74 million deaths among 30,3 million participants. BMJ. 2016;353:i2156. doi:10.1136/bmj.i2156

14. Nakamura K, Fuster J, Walsh K. Adipokines: a link between obesity and cardiovascular disease. J Cardiol. 2014;63(4):250–259. doi:10.1016/j.jjcc.2013.11.006

15. Boyarinova MA, Rotar OP, Erina AM, Paskar NA, Alieva AS, Moguchaia EV et al. Metabolically healthy obesity: predictors of transformation to unhealthy phenotype in St Petersburg population (according to the ESSE-RF study). Arterial’naya Gipertenziya = Arterial Hypertension. 2021;27(3):279–290. doi:10.18705/1607- 419X2021-27-3-279-290. In Russian.

16. Ohnishi H, Saitoh S, Akasaka H, Mitsumata K, Chiba M, Furugen M et al. Incidence of hypertension in individuals with abdominal obesity in a Rural Japanese Population: The Tanno and Sobetsu Study. Hypertens Res. 2008;31(7):1385–1390. doi:10.1291/hypres.31.1385

17. Mancusi C, Gerdts E, Losi MA, D’Amato A, Manzi MV, Canciello G et al. Differential effect of obesity on prevalence of cardiac and carotid target organ damage in hypertension (the Campania Salute Network). Int J Cardiol. 2017;244:260–264. doi:10.1016/j.ijcard.2017.06.045

18. Guo Y, Yue X, Li H, Song ZX, Yan HQ, Zhang P et al. Overweight and obesity in young adulthood and the risk of stroke: a meta-analysis. J Stroke Cerebrovasc Dis. 2016;25(12):2995–3004. doi:10.1016/j.jstrokecerebrovasdis.2016.08.018

19. Salvatore SP, Chevalier JM, Kuo SF, Audia PF, Seshan SV. Kidney disease in patients with obesity: It is not always obesityrelated glomerulopathy alone. Obes Res Clin Pract. 2017;11(5):597– 606.

20. Zhernakova YuV, Zheleznova EA, Chazova IE, Oshchepkova EV, Dolgusheva YuA, Yarovaya EB et al. The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study — ESSE-RF. Ther Arch. 2018;90(10):14–22. doi:10.26442/terarkh2018901014-22. In Russian.

21. Barry V, Baruth M, Beets M, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis. 2014;56(4):382–390. doi:10.1016/j.pcad.2013.09.002