Date of Award

2006

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Graduate Studies

First Advisor

Daniel T. Lackland

Second Advisor

Brent M. Egan

Third Advisor

Stuart Lipsitz

Fourth Advisor

Peter W. F. Wilson

Fifth Advisor

Robert F. Woolson

Abstract

Introduction The prevalence of obesity is increasing in all segments of the population. While excess body mass is associated with increased disease risks, the magnitude of the risks are unclear from existing studies. In this dissertation we examine the association between BMI and cardiovascular outcomes, CHD, stroke and CVD mortality and blood pressure in four gender-race subgroups. Methods This study uses Black Pooling Project data which includes subject level data on 27,691 men and women and 450,962 person-years of follow-up. Analysis includes linear regression and Cox Proportional Hazard models and is gender-race specific. Subject-level meta-analysis is used to obtain overall estimates of effect. Results: As a group, blacks have a higher adjusted mean systolic blood pressure than whites and are classified as hypertensive at all BMI categories whereas in whites blood pressure did not reach the hypertensive range until a BMI of at least 31 kg/m2. The age adjusted rise in blood pressure for a BMI increase of25-30 kg/m2, is greater for white than black women (5.9±0.2 vs. 4.4±0.5 p=0.005) and for white than black men (6.0±0.3 vs. 4.3±0.7 p=0.03). The adjusted relative risks for CHD, stroke and CVD mortality is significant for obesity in whites but not in blacks. In obese whites, the relative risk for C\lD mortality is (1.59[l.20-2.09]) in women (1.21 [1.04-1.41]) in women >60 years. There are no such significant associations for black women. Conclusions Obesity has a greater impact on blood pressure and CHD, stroke and CVD mortality in whites than blacks. While obesity prevention and treatment are recommended for all, these findings suggest that these efforts will have a greater impact on lowering blood pressure and reducing cardiovascular mortality in whites than blacks.

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