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What is the link between obesity and sudden death?

Johnson Francis
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Increased body mass index has been associated with increased risk of sudden cardiac death. For every five unit increase in BMI there is an associated 16% increased risk of SCD. Though the highest risk is among those with high BMI, higher risk has also been noted in those with low BMI, suggesting a J-curve phenomenon. Those with normal BMI have the lowest risk of SCD [1]. Seattle Proportional Risk Model evaluated 9885 patients with heart failure without implantable defibrillators, of whom 2552 died during an average follow-up of 2.3 years. They found that higher body mass index was independently associated with a greater proportional risk of sudden death [2].

Visceral obesity has a stronger risk for SCD than elevated BMI. A 0.1 unit increase in waist hip ratio was associated with 82% increased risk of sudden cardiac death. Increased risk of SCD with visceral obesity is noted in both males and females [3]. Nurses Health Study documented that abdominal obesity was strongly associated with all cause and cardiovascular mortality in addition to increased cancer mortality [4]. Obesity is an important risk factor for SCD independent of conventional cardiovascular risk factors. A study of over ten thousand middle aged subjects found that body mass index of 30 or more was associated with 79% increase in risk of SCD after adjustment for age, gender, smoking, blood pressure, diabetes, cholesterol, baseline cardiac disease and ECG abnormalities [5,6].

References

  1. Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018 Aug;33(8):711-722. doi: 10.1007/s10654-017-0353-9. Epub 2018 Feb 7. PMID: 29417316; PMCID: PMC6061127.
  2. Shadman R, Poole JE, Dardas TF, Mozaffarian D, Cleland JG, Swedberg K, Maggioni AP, Anand IS, Carson PE, Miller AB, Levy WC. A novel method to predict the proportional risk of sudden cardiac death in heart failure: Derivation of the Seattle Proportional Risk Model. Heart Rhythm. 2015 Oct;12(10):2069-77. doi: 10.1016/j.hrthm.2015.06.039. Epub 2015 Jun 30. PMID: 26142301.
  3. Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018 Aug;33(8):711-722. doi: 10.1007/s10654-017-0353-9. Epub 2018 Feb 7. PMID: 29417316; PMCID: PMC6061127.
  4. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation. 2008 Apr 1;117(13):1658-67. doi: 10.1161/CIRCULATIONAHA.107.739714. Epub 2008 Mar 24. PMID: 18362231.
  5. Holmstrom L, Junttila J, Chugh SS. Sudden Death in Obesity: Mechanisms and Management. J Am Coll Cardiol. 2024 Dec 3;84(23):2308-2324. doi: 10.1016/j.jacc.2024.09.016. Epub 2024 Nov 6. PMID: 39503654.
  6. Eranti A, Aro AL, Kerola T, Tikkanen JT, Rissanen HA, Anttonen O, Junttila MJ, Knekt P, Huikuri HV. Body Mass Index as a Predictor of Sudden Cardiac Death and Usefulness of the Electrocardiogram for Risk Stratification. Am J Cardiol. 2016 Feb 1;117(3):388-93. doi: 10.1016/j.amjcard.2015.10.057. Epub 2015 Nov 18. PMID: 26723105.
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