Sex-Specific Associations Between Overweight Obesity and 16 Cardio- and Cerebrovascular Diseases: A Real-World Evidence Study From German General Practices
Author(s)
Céline Vetter, PhD1, Ximena Orozco Ruiz, PhD1, Karel Kostev, MA, DrPH, MD2.
1IQVIA Commercial GmbH & Co. OHG, Frankfurt a.M., Germany, 2IQVIA Commercial GmbH & Co. OHG, Franfurt a.M., Germany.
1IQVIA Commercial GmbH & Co. OHG, Frankfurt a.M., Germany, 2IQVIA Commercial GmbH & Co. OHG, Franfurt a.M., Germany.
OBJECTIVES: While obesity is a known risk factor for cardiovascular disease, its differential impact across a broad spectrum of specific cardiac and vascular conditions—particularly by sex—remains underexplored. This study aimed to quantify associations between body weight categories and the incidence of 16 distinct cardio- and cerebrovascular diseases using real-world data from general practices in Germany.
METHODS: We conducted a retrospective cohort study using electronic medical records from the Disease Analyzer database (IQVIA), including 233,730 adults with normal weight (n=80,702), overweight (n=90,527), or obesity (n=62,501) from 677 general practices between 2005 and 2023. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for each disease outcome, stratified by sex.
RESULTS: Obesity was significantly associated with increased risk for heart failure (HR: 1.95), myocardial infarction (HR: 1.95), pulmonary embolism (HR: 1.83), atrial fibrillation (HR: 1.63), and cardiomyopathy (HR: 1.60), among others. Sex-specific analyses revealed stronger associations in men for atrial fibrillation (HR: 1.75 vs. 1.51 in women) and cardiomyopathy (HR: 1.97 vs. non-significant). Conversely, women showed stronger associations for pulmonary embolism (HR: 2.09 vs. 1.57 in men) and phlebitis (HR: 1.69 vs. 1.47). Obesity was inversely associated with hemorrhagic stroke in men (HR: 0.60), and with aneurysm and peripheral vascular disease in women (HR: 0.73 and 0.86, respectively).
CONCLUSIONS: This large-scale real-world study highlights the heterogeneous and sex-specific cardiovascular risks associated with excess weight. These findings support the need for tailored prevention strategies that consider both BMI category and sex to more effectively mitigate cardiovascular disease burden.
METHODS: We conducted a retrospective cohort study using electronic medical records from the Disease Analyzer database (IQVIA), including 233,730 adults with normal weight (n=80,702), overweight (n=90,527), or obesity (n=62,501) from 677 general practices between 2005 and 2023. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for each disease outcome, stratified by sex.
RESULTS: Obesity was significantly associated with increased risk for heart failure (HR: 1.95), myocardial infarction (HR: 1.95), pulmonary embolism (HR: 1.83), atrial fibrillation (HR: 1.63), and cardiomyopathy (HR: 1.60), among others. Sex-specific analyses revealed stronger associations in men for atrial fibrillation (HR: 1.75 vs. 1.51 in women) and cardiomyopathy (HR: 1.97 vs. non-significant). Conversely, women showed stronger associations for pulmonary embolism (HR: 2.09 vs. 1.57 in men) and phlebitis (HR: 1.69 vs. 1.47). Obesity was inversely associated with hemorrhagic stroke in men (HR: 0.60), and with aneurysm and peripheral vascular disease in women (HR: 0.73 and 0.86, respectively).
CONCLUSIONS: This large-scale real-world study highlights the heterogeneous and sex-specific cardiovascular risks associated with excess weight. These findings support the need for tailored prevention strategies that consider both BMI category and sex to more effectively mitigate cardiovascular disease burden.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH214
Topic
Epidemiology & Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)