Cardiometabolic & kidneyCohort study
Prospective Associations of Obesity and Obesity Severity With 9 Cardiovascular Outcomes: The Cross-Cohort Collaboration
- Pooled prospective cohort study
- 21 cohorts
- multivariable Cox models with restricted cubic splines
Authors' conclusion
Higher BMI was robustly associated with increased risk for most outcomes, particularly HF and AF, even after adjusting for traditional risk factors.
Study context
- Population
- Adults with body mass index (BMI) ≥18.5 kg/m² from 21 cohorts of the Cross-Cohort Collaboration enrolled 1948–2015 (mean age 60.3 years; 79.2% women)
- Participants
- 289,875 adults · 21 cohorts
- Exposure
- BMI categories vs normal weight
- Outcome
- 9 CV outcomes: Myocardial infarction (MI), stroke, heart failure (HF), atrial fibrillation (AF), total coronary heart disease (CHD), total CVD, CHD mortality, CVD mortality, all-cause mortality
- Follow-up
- Median 19.2 years
Main finding
As reported in the abstract
Each group vs normal weightHazard ratio (95% CI)
Class 2 obesityHF
2.1(2.0–2.3)
Class 3 obesityHF
3.0(2.7–3.2)
Class 2 obesityAF
1.8(1.7–2.0)
Class 3 obesityAF
2.8(2.5–3.1)
Observational data: associations, not effects.
Further findings
Stroke, cardiovascular disease (CVD) and all-cause mortality by sex (subgroup)
- Women had higher relative increases in risk with severe obesity than men for stroke, CVD and all-cause mortality
- interaction P <0.001, 0.003, <0.001
- Men: no increase in stroke risk with higher BMI categories
- P for trend = 0.49
- Women: stroke risk plateaued across obesity subclasses yet remained significantly increased vs normal weight
Original publication
Prospective Associations of Obesity and Obesity Severity With 9 Cardiovascular Outcomes: The Cross-Cohort Collaboration. Circulation. Published 12 February 2026. doi:10.1161/circulationaha.125.075327
Summarised from the published abstract; every number is checked against it