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Prospective Studies Collaboration Lancet 2009; 373:

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Presentation on theme: "Prospective Studies Collaboration Lancet 2009; 373:"— Presentation transcript:

1 Prospective Studies Collaboration Lancet 2009; 373: 1083-96
Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies Prospective Studies Collaboration Lancet 2009; 373:

2 Blood pressure, cholesterol and BMI
160 5 M Non-HDL-C Systolic M 140 4 Ratio of means (non-HDL-C/HDL-C) F F 120 M 3 F mmol/L (or ratio) mm Hg 100 2 F M Diastolic Blood pressure and cholesterol fractions versus BMI at baseline in the range 15–50 kg/m². Adjusted for baseline age, baseline smoking status and study. Numerical values are shown for 20–22·5 kg/m², for 30–32·5 kg/m², and for the extreme BMI groups. Boundaries of BMI groups are indicated by tick marks. 95% CIs are not shown, but most are narrower than the heights of the plotted symbols. Blood pressure on left (in males and females). Blood cholesterol fractions on right (in males and females with total and HDL cholesterol both measured); dashed line indicates the ratio of mean non-HDL cholesterol to mean HDL cholesterol (mean of the individual ratios is about 8–12% greater: see next slide). HDL-C 80 F 1 M 15 25 35 50 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1a & b, Lancet 2009; 373:

3 Ratio non-HDL:HDL cholesterol and BMI
5 M Mean of ratios 4 Ratio of means 3 Ratio F 2 (Mean of ratios ~10% higher than ratio of means) Cholesterol fractions versus BMI at baseline in the range 15–50 kg/m². Blood cholesterol fractions (in males and females with total and HDL cholesterol both measured) versus BMI. Symbols connected by dashed line indicates the ratio of mean non-HDL cholesterol to mean HDL cholesterol (as in the previous slide); symbols not connected by any line indicate the mean of the individual ratios. Conventions as in the previous slide. 1 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1b variant, Lancet 2009; 373:

4 Drinking, smoking, diabetes and BMI
Male Female 100 100 80 80 Drinking 60 60 Prevalence% 40 40 Drinking Smoking Drinking, smoking and diabetes versus BMI at baseline in the range 15–50 kg/m². Adjusted for baseline age, baseline smoking status (apart from the smoking findings), and study. Numerical values are shown for 20–22·5 kg/m², for 30–32·5 kg/m², and for the extreme BMI groups. Boundaries of BMI groups are indicated by tick marks. 95% CIs are not shown, but most are narrower than the heights of the plotted symbols. At left are the prevalences in males for alcohol drinking ( ), cigarette smoking ( ), and diabetes ( ). At right are the prevalences in females for alcohol drinking ( ), cigarette smoking ( ), and diabetes ( ). 20 20 Smoking Diabetes Diabetes 15 25 35 50 15 25 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study Fig 1c & d, Lancet 2009; 373:

5 All-cause mortality and BMI
64 Male 32 Annual deaths per 1000 Female 16 & 95% CI (floated so matches PSC rate at ages 35-79) All-cause mortality versus BMI for each sex in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–89 years, adjusted for age at risk, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the PSC mortality rate at ages 35–79 years. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. Dotted vertical line indicates 25 kg/m² (boundary between upper and lower BMI ranges in this report). 8 4 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Fig 2, Lancet 2009; 373:

6 IHD and stroke mortality and BMI
8 IHD Annual deaths per 1000 4 Stroke 2 & 95% CI (floated so matches PSC rate at ages 35-79) Ischaemic heart disease and stroke mortality versus BMI in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–89 years, adjusted for age at risk, sex, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the PSC mortality rate at ages 35–79 years. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 1 0·5 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Fig 3, Lancet 2009; 373:

7 IHD mortality and BMI in the range 25–50 kg/m2 only
No. of Mean age HR & 95% CI deaths at death Follow-up period (years) 0-4* 2069 60·2 1·26 (1·16-1·36) 5-9 3291 62·9 1·33 (1·24-1·43) 10-14 3407 66·1 1·43 (1·33-1·53) 15+ 4085 71·2 1·42 (1·34-1·51) Trend, 4 groups: c 2 1 =6·6 (p=0·01) Age at risk (years) 35-59 2461 54·1 1·50 (1·39-1·62) 60-69 3904 64·6 1·40 (1·32-1·49) 70-79 3264 74·0 1·31 (1·23-1·40) 80-89 1154 83·4 1·30 (1·17-1·45) Trend, 4 groups: c 2 1 =7·8 (p=0·005) Sex Male 8556 65·7 1·42 (1·35-1·48) Female 2227 72·4 1·35 (1·28-1·43) Heterogeneity: c 1 2 =1·4 (p=0·2) Smoking at entry Never smoker 2651 71·0 1·41 (1·33-1·50) Other/unknown 3442 68·0 1·45 (1·36-1·54) Current cigarette 4690 64·1 1·33 (1·25-1·41) Heterogeneity: c 2 2 =3·7 (p=0·2) Ischaemic heart disease versus BMI in the upper BMI range (25–50 kg/m²) only (excluding the first 5 years of follow-up, except as indicated). Hazard ratios are per 5 kg/m²—eg, 30 kg/m² versus 25 kg/m²—and are, when appropriate, adjusted for age at risk, sex, smoking, and study. Mean ages at death are given, but the dependence of the HR on mean age at death is not corrected for in analyses of factors other than age. The area of each square is inversely proportional to the variance of the log hazard ratio. White squares include the first 5 years of follow-up; black squares and white diamonds do not. All (BMI kg/m2, years 5+) 10 783 67·1 1·39 (1·34-1·44) 1·0 1·5 2 Hazard ratio (& 95% CI) for 5 kg/m2 higher baseline BMI Adjusted, when appropriate, for age, sex, smoking and study, and (except where marked *) 1st 5 years of follow-up excluded Fig 4a, Lancet 2009; 373:

8 Stroke mortality and BMI in the range 25–50 kg/m2 only
No. of Mean age HR & 95% CI deaths at death Follow-up period (years) 0-4* 583 62·5 1·21 (1·05-1·41) 5-9 889 65·6 1·36 (1·20-1·54) 10-14 906 69·0 1·37 (1·20-1·56) 15+ 1369 73·4 1·38 (1·24-1·53) Trend, 4 groups: c 2 1 =1·4 (p=0·2) Age at risk (years) 35-59 463 53·7 1·76 (1·52-2·04) 60-69 997 64·9 1·49 (1·34-1·67) 70-79 1152 74·3 1·33 (1·19-1·48) 80-89 552 83·5 1·10 (0·94-1·30) Trend, 4 groups: c 1 2 =19·4 (p<0·0001) Sex Male 2132 68·4 1·50 (1·38-1·65) Female 1032 73·2 1·30 (1·19-1·42) Heterogeneity: c 2 1 =5·4 (p=0·02) Smoking at entry Never smoker 1062 72·7 1·38 (1·25-1·52) Other/unknown 921 71·1 1·47 (1·30-1·65) Current cigarette 1181 66·5 1·34 (1·20-1·50) Heterogeneity: c 2 2 =1·2 (p=0·6) Stroke mortality versus BMI in the upper BMI range (25–50 kg/m²) only (excluding the first 5 years of follow-up, except as indicated). Hazard ratios are per 5 kg/m²—eg, 30 kg/m² versus 25 kg/m²—and are, when appropriate, adjusted for age at risk, sex, smoking, and study. Mean ages at death are given, but the dependence of the HR on mean age at death is not corrected for in analyses of factors other than age. The area of each square is inversely proportional to the variance of the log hazard ratio. White squares include the first 5 years of follow-up; black squares and white diamonds do not. Subarachnoid=subarachnoid haemorrhage (not included in haemorrhagic stroke). Stroke subtype Never smoker 765 71·8 1·38 (1·23-1·56) Other/unknown 571 66·2 1·53 (1·32-1·78) Current cigarette 242 61·0 1·19 (0·94-1·52) Current cigarette 1586 71·8 1·40 (1·28-1·53) Heterogeneity: c 3 2 =3·2 (p=0·4) All (BMI kg/m2, years 5+) 3164 69·9 1·39 (1·31-1·48) 1 1·5 2 Hazard ratio (& 95% CI) for kg/m2 higher baseline BMI Adjusted, when appropriate, for age, sex, smoking and study, and (except where marked *) 1st 5 years of follow-up excluded Fig 4b, Lancet 2009; 373:

9 IHD & stroke mortality and BMI in the range 25–50 kg/m2 only
Approximately standardised to overall mean age at IHD, or at stroke, death IHD Stroke No. of Mean age No. of Mean age HR & 95% CI HR & 95% CI deaths at death deaths at death Follow­up period (years) 0-4* 2069 60·2 1·20 (1·10-1·30) 583 62·5 1·08 (0·93-1·26) 5-9 3291 62·9 1·29 (1·21-1·39) 889 65·6 1·27 (1·12-1·44) 10-14 3407 66·1 1·42 (1·32-1·52) 906 69·0 1·35 (1·19-1·54) 15+ 4085 71·2 1·46 (1·38-1·55) 1369 73·4 1·45 (1·31-1·61) Trend, 4 groups: Trend, 4 groups: c 2 =17·3 (p<0·0001) c 2 =10·1 (p=0·002) 1 1 Sex Male 8556 65·7 1·40 (1·34-1·47) 2132 68·4 1·47 (1·34-1·61) Female 2227 72·4 1·40 (1·33-1·49) 1032 73·2 1·36 (1·25-1·49) Heterogeneity: Heterogeneity: c 2 =0·0 (p=1·0) c 1 2 =1·4 (p=0·2) 1 Smoking Never smoker 2651 71·0 1·45 (1·36-1·54) 1062 72·7 1·44 (1·31-1·59) at entry Other/unknown 3442 68·0 1·46 (1·37-1·55) 921 71·1 1·49 (1·33-1·68) Ischaemic heart disease and stroke mortality versus BMI in the upper BMI range (25–50 kg/m²) only (excluding the first 5 years of follow-up, except as indicated). Conventions as in the previous two slides except all hazard ratios are approximately standardised for age at death. Factor per year of age by which the hazard ratios are changed: for IHD,1.015 for stroke. Current cigarette 4690 64·1 1·30 (1·23-1·38) 1181 66·5 1·27 (1·13-1·43) Heterogeneity: Heterogeneity: c 2 =8·1 (p=0·02) c 2 =4·2 (p=0·1) 2 2 All (BMI 25-50, years 5+) 10 783 67·1 1·39 (1·34-1·44) 3164 69·9 1·39 (1·31-1·48) 1 1·5 2 1 1·5 2 Hazard ratio (& 95% CI) for kg/m2 higher baseline BMI Adjusted, when appropriate, for age, sex, smoking and study, and (except where marked *) 1st 5 years of follow-up excluded Fig 4 variant, Lancet 2009; 373:

10 Main mortality categories and BMI
Male Female 14 14 Vascular 12 12 Annual deaths per 1000 10 10 8 8 6 6 & 95% CI (floated so matches EU rate at ages 35-79) Vascular Cancer (other specified) Mortality rates at ages 35–79 years for main disease categories versus BMI in the range 15–50 kg/m² (excluding the first 5 years of follow-up). Relative risks at ages 35–79 years, adjusted for age at risk, smoking, and study, were multiplied by a common factor (ie, floated) to make the weighted average match the age-standardised European Union (15 countries) mortality rate at ages 35–79 years in Neoplastic mortality is split into the types most strongly associated with smoking (cancers of the lung and upper aerodigestive tract) and all other specified types. By contrast with figures 2–4, risk is indicated on an additive rather than multiplicative scale, with floated mortality rates shown above or below each symbol. The estimates for 35–50 kg/m² are based on limited data, so lines connecting to those estimates are dashed. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 4 4 Cancer (other specified) Cancer (lung, mouth, pharynx, larynx, oes.) 2 2 Cancer (lung, mouth, pharynx, larynx, oes.) Resp. Respiratory 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Fig 5, Lancet 2009; 373:

11 All-cause mortality and BMI, by smoking
30 Current cigarette smoker 25 Annual deaths per 1000 20 Never smoked regularly 15 & 95% CI (floated so matches EU rate at ages 35-79) 10 (N.B. The vertical separation of the curves underestimates effects of lifelong cigarette smoking) All-cause mortality at ages 35–79 years versus BMI in the range 15–50 kg/m², by smoking status (excluding the first 5 years of follow-up). Relative risks at ages 35–79 years, adjusted for age at risk, sex, and study, were multiplied by a common factor (ie, floated) so that the mean for all participants (including ex-smokers and anyone with missing smoking data) matches the European rate at ages 35–79 years in Results for ex-smokers and those with missing smoking data not shown (but are, taken together, only slightly above those for never smokers). Note that many smokers were at only limited risk, since they had not smoked many cigarettes during early adult life, or had stopped shortly after the baseline survey. Risk is indicated on an additive rather than multiplicative scale. The estimates for 35–50 kg/m² are based on limited data, so lines connecting to those estimates are dashed. Floated mortality rates shown above each square and numbers of deaths below. Area of square is inversely proportional to the variance of the log risk. Boundaries of BMI groups are indicated by tick marks. 95% CIs for floated rates reflect uncertainty in the log risk for each single rate. 5 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex and study; 1st 5 years of follow-up excluded Fig 6, Lancet 2009; 373:

12 Lifespan and BMI in western Europe, year 2000
Male Female 100 100 88% 80 77% 80 84% 69% % alive 60 60 Yearly dots 40 40 BMI range, kg/m2 BMI versus lifespan in western Europe, year 2000 (3 main BMI categories). Estimated effects of the BMI that would be reached by about 60 years of age on survival from age 35 years, identifying European Union (EU) mortality rates in 2000 with those for BMI 25–30 kg/m² and combining the disease-specific EU mortality rates with disease-specific relative risks (for details, see webappendix pp 18–20). The absolute differences in median survival (but probably not in survival to age 70 years) should be robust to changes in mortality rates, and therefore generalisable decades hence. (mean 24) 20 20 25-30 (mean 27) 30-35 (mean 32) 40 50 60 70 80 90 100 40 50 60 70 80 90 100 Age (years) Causal PSC relative risks applied to EU mortality rates Fig 7 variant, Lancet 2009; 373:

13 Lifespan and BMI in western Europe, year 2000
Male Female 100 100 88% 80 77% 80 72% % alive 60 60 Yearly dots 49% 40 BMI range, kg/m2 40 (mean 24) 25-30 BMI versus lifespan in western Europe, year 2000 (3 main and 2 higher BMI categories). Estimated effects of the BMI that would be reached by about 60 years of age on survival from age 35 years, identifying European Union (EU) mortality rates in 2000 with those for BMI 25–30 kg/m² and combining the disease-specific EU mortality rates with disease-specific relative risks (for details, see webappendix pp 18–20). The absolute differences in median survival (but probably not in survival to age 70 years) should be robust to changes in mortality rates, and therefore generalisable decades hence. (Note that the 2 higher BMI categories account for just 2% of PSC participants, and so are indicated by dashed lines.) 20 30-35 (mean 32) 20 35-40 40-50 (mean 43) 40 50 60 70 80 90 100 40 50 60 70 80 90 100 Age (years) Causal PSC relative risks applied to EU mortality rates Fig 7, Lancet 2009; 373:

14 Comparison with smoking in the British Doctors’ Study
British Doctors’ Study. Survival from age 35 for continuing cigarette smokers and lifelong non-smokers among UK male doctors born , with percentages alive at each decade of age. From figure 3 in Doll, Peto et al., BMJ 2004: 328:

15 All-cause mortality and BMI, by age at risk
Male Female Age at risk: 512 512 Age at risk: 256 80-89 256 80-89 128 70-79 128 Annual deaths per 1000 70-79 64 64 60-69 32 32 60-69 & 95% CI (floated so matches PSC rate at ages 35-89) 16 16 35-59 All-cause mortality vs. BMI in the range kg/m2, by age at risk (excluding the first 5 years of follow-up). Conventions as in figure 2 (ie, slide 5). 8 8 35-59 4 4 2 2 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, smoking and study; 1st 5 years of follow-up excluded Webfig 1, Lancet 2009; 373:

16 IHD mortality and BMI in never smokers
16 8 Annual deaths per 1000 4 2 & 95% CI (floated so matches PSC rate at ages 35-79) IHD mortality vs. BMI for never-smokers in the range kg/m2 (excluding the first 5 years of follow-up). Conventions as in figure 2 (ie, slide 5), except not adjusted for smoking. 1 0·5 15 20 25 30 35 40 50 Baseline BMI (kg/m2) Adjusted for age, sex and study; 1st 5 years of follow-up excluded Webfig 2, Lancet 2009; 373:

17 Stroke mortality and BMI in specific subgroups
Excluding: first 5 years of follow­up first 10 years of follow­up first 5 years and ever smokers 4 4 4 Annual deaths per 1000 2 2 2 & 95% CI (floated so matches PSC rate at ages 35-79) Stroke mortality vs. BMI in the range kg/m2, excluding the first 5 years of follow-up, the first 10 years of follow-up, or the first 5 years of follow-up and those who had ever smoked. Conventions as in figure 2 (ie, slide 5), except rightmost graph not adjusted for smoking. 1 1 1 15 20 25 30 35 50 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex, study and, when appropriate, smoking Webfig 3, Lancet 2009; 373:

18 Stroke subtype mortality and BMI
Ischaemic Haemorrhagic Unclassified 2 2 2 Annual deaths per 1000 1 1 1 1/2 1/2 1/2 & 95% CI (floated so matches PSC rate at ages 35-79) Stroke subtype mortality vs. BMI in the range kg/m2 (excluding the first 5 years of follow-up). Conventions as in figure 2 (ie, slide 5). 1/4 1/4 1/4 15 20 25 30 35 50 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study; 1st 5 years of follow-up excluded Webfig 4, Lancet 2009; 373:

19 IHD mortality and BMI by study
No. of Study deaths Finnish Mobile Clinic 1724 Finrisk, Finland 1014 UK HDPP 703 Israeli IHD 571 Whitehall, UK 568 NHEFS, US 494 Framingham, US 481 Renfrew/Paisley, UK 438 Norwegian Counties 438 BUPA, UK 362 Oslo, Norway 339 Midspan, UK 318 Copenhagen, Denmark 231 IHD mortality vs. BMI, by study: hazard ratio per 5 kg/m2 higher BMI in the range kg/m2 (excluding the first 5 years of follow-up). Conventions as in figure 4 (ie, slides 7-8), except: (i) hazard ratios adjusted for baseline age rather than age at risk (cf. Methods); and (ii) white squares represent inverse-variance-weighted averages for smaller studies. Dotted line indicates hazard ratio 1.39 (cf. IHD results in webtable 6). Study names as in webtable 1. BRHS, UK 227 Busselton, Australia 222 Tecumseh, US 215 Studies with <200 deaths 2438 ALL STUDIES 10 783 0·8 1·0 1·4 2·0 2·8 Hazard ratio (& 99% CI) for Test for heterogeneity: c 2 =22·5 (p=0·13) 16 5 kg/m2 higher baseline BMI Adjusted for age, sex and smoking; 1st 5 years of follow-up excluded Webfig 5a, Lancet 2009; 373:

20 Stroke mortality and BMI by study
No. of Study deaths Finnish Mobile Clinic 556 Finrisk, Finland 270 Israeli IHD 206 NHEFS, US 148 Renfrew/Paisley, UK 143 Framingham, US 133 UK HDPP 122 Honolulu, US 111 Studies with <100 deaths 1475 Stroke mortality vs. BMI, by study: hazard ratio per 5 kg/m2 higher BMI in the range kg/m2 (excluding the first 5 years of follow-up). Conventions as in figure 4 (ie, slides 7-8), except: (i) hazard ratios adjusted for baseline age rather than age at risk (cf. Methods); and (ii) white squares represent inverse-variance-weighted averages for smaller studies. Dotted line indicates hazard ratio 1.39 (cf. stroke results in webtable 6). Study names as in webtable 1. ALL STUDIES 3164 0·8 1·0 1·4 2·0 2·8 Test for heterogeneity: c 2 =6·1 (p=0·64) Hazard ratio (& 99% CI) for 8 5 kg/m2 higher baseline BMI Adjusted for age, sex and smoking; 1st 5 years of follow-up excluded Webfig 5b, Lancet 2009; 373:

21 COPD mortality and BMI by follow-up period
0-4 years 5-9 years 10-14 years 15+ years 4 4 4 4 Annual deaths per 1000 2 2 2 2 1 1 1 1 1/2 1/2 1/2 1/2 & 95% CI (floated so matches PSC rate at ages 35-79) 1/4 1/4 1/4 1/4 1/8 1/8 1/8 1/8 COPD mortality vs. BMI in the range kg/m2 (by follow-up period). Conventions as in figure 2 (ie, slide 5). Results for kg/m2 not plotted because of small numbers of deaths. 15 20 25 30 35 15 20 25 30 35 15 20 25 30 35 15 20 25 30 35 Baseline BMI (kg/m2) Adjusted for age, sex, smoking and study Webfig 6, Lancet 2009; 373:

22 All-cause mortality and BMI by smoking
Male (35-69 years) Female (35-69 years) 20 20 Current cigarette smoker 15 15 Annual deaths per 1000 Never smoked regularly Current cigarette smoker 10 10 & 95% CI (floated so matches EU rate at ages 35-69) All-cause mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). For kg/m2, only the upper or only the lower part of the CI is shown. Never smoked regularly 5 5 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7a & b, Lancet 2009; 373:

23 All-cause mortality and BMI by smoking
Male (70-79 years) Female (70-79 years) 100 100 Current cigarette smoker Annual deaths per 1000 75 75 Never smoked regularly Current cigarette smoker 50 50 & 95% CI (floated so matches EU rate at ages 70-79) Never smoked regularly All-cause mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). For kg/m2, only the upper or only the lower part of the CI is shown. 25 25 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 7c & d, Lancet 2009; 373:

24 Vascular mortality and BMI by smoking
Male (35-69 years) Female (35-69 years) 6 6 Current cigarette smoker Annual deaths per 1000 4 4 Never smoked regularly Current cigarette smoker & 95% CI (floated so matches EU rate at ages 35-69) 2 2 Vascular mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). Results for kg/m2 not plotted because of small numbers of deaths. Never smoked regularly 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8a & b, Lancet 2009; 373:

25 Vascular mortality and BMI by smoking
Male (70-79 years) Female (70-79 years) 30 30 Current cigarette smoker Annual deaths per 1000 20 Never smoked regularly 20 Current cigarette smoker & 95% CI (floated so matches EU rate at ages 35-79) Never smoked regularly 10 10 Vascular mortality at age years vs. BMI by baseline smoking status (excluding the first 5 years of follow-up). Conventions as in figure 6 (ie, slide 11). Results for kg/m2 not plotted because of small numbers of deaths. 15 20 25 30 35 50 15 20 25 30 35 50 Baseline BMI (kg/m2) Adjusted for age and study; 1st 5 years of follow-up excluded Webfig 8c & d, Lancet 2009; 373:


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