Original Article

ASEAN Heart Journal

, 22:18

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Elevated cardiovascular risk factors in a young, asymptomatic and physically active population within a normal body mass index

  • Lee GKAffiliated withDepartment of Medicine, National University Health System
  • , Sim HWAffiliated withDepartment of Medicine, National University Health System
  • , Tan YAffiliated withDepartment of Medicine, National University Health System
  • , Ma TAffiliated withHealth for Life Program, Khoo Teck Puat Hospital
  • , Liew KHAffiliated withHealth for Life Program, Khoo Teck Puat Hospital
  • , Tan ECAffiliated withHealth for Life Program, Khoo Teck Puat Hospital
  • , Lee LCAffiliated withGleneagles Hospital Penang
  • , Sum CFAffiliated withDepartments of Medicine and Cardiology, Khoo Teck Puat Hospital
  • , Ong HYAffiliated withDepartments of Medicine and Cardiology, Khoo Teck Puat Hospital Email author 

Abstract

Background:

Obesity is associated with significant morbidity and mortality. The body mass index (BMI) is a simple and inexpensive technique to quantify obesity. In a low-risk population, we aim to determine the association of BMI with cardiovascular risk factors (CVRFs) including undiagnosed diabetes.

Methods:

We studied 3026 subjects referred for routine health screening. Patients with pre-existing diabetes mellitus and/or vascular disease were excluded. Each subject had anthropometric measurements and CVRF parameters (blood pressure, fasting lipids and fasting glucose) taken.

Results:

The mean age was 38.9 ± 5.4 years, 89.9% male. Chinese persons comprised 58.6% of our cohort, Malays 34.0% and Indians 7.4%. The majority (84.5%) of subjects were low-risk (10-year risk <10%) for cardiac events using the FRS algorithm. The mean BMI was 25.2kg/m2. A positive correlation was seen between BMI and prevalence of CVRFs (p<0.001 for all). Serum lipid levels worsen significantly beyond a BMI of 20.0kg/m2, while blood pressure worsens significantly beyond a BMI of 22.0kg/m2. A positive relationship between BMI and the prevalence of impaired fasting glucose and frank diabetes was noted for BMIs ≥20.0kg/m2 (p<0.001); no subject below 20.0kg/m2 had frank diabetes.

Conclusion:

A significant proportion of our subjects with a normal (Asian) BMI of <23.0kg/m2 had elevated CVRFs on routine screening. The step-wise rise and additive nature of these CVRFs and her consistent correlation with a rising BMI of >20.0kg/ m2 suggest that traditional cardiovascular risk factors can be reduced to very low levels by weight reduction alone.

Keywords:

body mass index Asian diabetes mellitus hypertension hyperlipidemia