0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Risks of Myocardial Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Indexes ONLINE FIRST

Peter Nordström, PhD1; Nancy L. Pedersen, PhD2; Yngve Gustafson, PhD1; Karl Michaëlsson, PhD3; Anna Nordström, PhD4
[+] Author Affiliations
1Section of Geriatrics, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
2Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
3Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
4Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
JAMA Intern Med. Published online August 01, 2016. doi:10.1001/jamainternmed.2016.4104
Text Size: A A A
Published online

Importance  Observational studies have shown that obesity is a major risk factor for cardiovascular disease and death. The extent of genetic confounding in these associations is unclear.

Objective  To compare the risk of myocardial infarction (MI), type 2 diabetes, and death in monozygotic (MZ) twin pairs discordant for body mass index (BMI).

Design, Setting, and Participants  A cohort of 4046 MZ twin pairs with discordant BMIs (difference >0.01) was identified using the nationwide Swedish twin registry. The study was conducted from March 17, 1998, to January 16, 2003, with follow-up regarding incident outcomes until December 31, 2013.

Main Outcomes and Measures  The combined primary end point of death or MI and the secondary end point of incident diabetes were evaluated in heavier compared with leaner twins in a co-twin control analysis using multivariable conditional logistic regression.

Results  Mean (SD) baseline age for both cohorts was 57.6 (9.5) years (range, 41.9-91.8 years). During a mean follow-up period of 12.4 (2.5) years, 203 MIs (5.0%) and 550 deaths (13.6%) occurred among heavier twins (mean [SD] BMI, 25.9 [3.6] [calculated as weight in kilograms divided by height in meters squared]) compared with 209 MIs (5.2%) and 633 deaths (15.6%) among leaner twins (mean [SD] BMI, 23.9 [3.1]; combined multivariable adjusted odds ratio [OR], 0.75; 95% CI, 0.63-0.91). Even in twin pairs with BMI discordance of 7.0 or more (mean [SE], 9.3 [0.7]), where the heavier twin had a BMI of 30.0 or more (n = 65 pairs), the risk of MI or death was not greater in heavier twins (OR, 0.42; 95% CI, 0.15-1.18). In contrast, in the total cohort of twins, the risk of incident diabetes was greater in heavier twins (OR, 2.14; 95% CI, 1.61-2.84). Finally, increases in BMI since 30 years before baseline were not associated with the later risk of MI or death (OR, 0.97; 95% CI, 0.89-1.05) but were associated with the risk of incident diabetes (OR, 1.13; 95% CI, 1.01-1.26).

Conclusions and Relevance  In MZ twin pairs, higher BMI was not associated with an increased risk of MI or death but was associated with the onset of diabetes. These results may suggest that lifestyle interventions to reduce obesity are more effective in decreasing the risk of diabetes than the risk of cardiovascular disease or death.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Risks of Myocardial Infarction and Death

Risks of myocardial infarction (A) and death (B) in twin pairs with higher vs lower body mass index with increasing follow-up time.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Risk of Myocardial Infarction (MI) or Death

Risks in 4046 monozygotic twin pairs, obtained by comparing those with higher and lower body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) in the total cohort and in specified subgroups. Odds ratios (ORs) and 95% CIs were adjusted for the influences of smoking habits and physical activity. The dashed line indicates the overall effect in the total sample.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Risk of Myocardial Infarction (MI) or Death

Risks in 4046 monozygotic twin pairs based on body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) differences within pairs. Odds ratios (ORs) and 95% CIs were adjusted for smoking and physical activity.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

2,205 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence To Support The Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

brightcove.createExperiences();