Adolescent Overweight and Future Adult Coronary Heart Disease

Kirsten Bibbins-Domingo, Ph.D., M.D., Pamela Coxson, Ph.D., Mark J. Pletcher, M.D., M.P.H., James Lightwood, Ph.D., and Lee Goldman, M.D., M.P.H.
Background The effect of adolescent overweight on future adult coronary heart disease (CHD) is not known.

Methods We estimated the prevalence of obese 35-year-olds in 2020 on the basis of adolescent overweight in 2000 and historical trends regarding overweight adolescents who become obese adults. We then used the CHD Policy Model, a state-transition computer simulation of U.S. residents who are 35 years of age or older, to project the annual excess incidence and prevalence of CHD, the total number of excess CHD events, and excess deaths from both CHD and other causes attributable to obesity from 2020 to 2035. We also modeled the effect of treating obesity-related increases in blood pressure and dyslipidemia.

Results Adolescent overweight is projected to increase the prevalence of obese 35-year-olds in 2020 to a range of 30 to 37% in men and 34 to 44% in women. As a consequence of this increased obesity, an increase in the incidence of CHD and in the total number of CHD events and deaths is projected to occur in young adulthood. The increase is projected to continue in both absolute and relative terms as the population reaches middle age. By 2035, it is estimated that the prevalence of CHD will increase by a range of 5 to 16%, with more than 100,000 excess cases of CHD attributable to the increased obesity. Aggressive treatment with currently available therapies to reverse modifiable obesity-related risk factors would reduce, but not eliminate, the projected increase in the number of CHD events.

Conclusions Although projections 25 or more years into the future are subject to innumerable uncertainties, extrapolation from current data suggests that adolescent overweight will increase rates of CHD among future young and middle-aged adults, resulting in substantial morbidity and mortality.