Low and high body mass index linked to fatal main artery disease
Underweight adults had 23% higher relative risk of death from main artery disease than those with body mass index 21–22.9 kilograms per square meter.
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Editor of record: Boris Djordjevic · AgingResearch.News
The 15,146,946 Korean men and women aged 18–99 were followed in a prospective observational cohort study. Health checks in 2003–2006 recorded body mass index, a measure of weight relative to height. National death records identified 4,299 deaths over a median 14.3 years from aortic aneurysm, a bulge in the body's main artery, or dissection, a tear in its inner wall.
Death risk was lowest at body mass index 21–22.9 kilograms per square meter. Both lower and higher values were linked to higher risk. At 35 or above, the hazard ratio—a relative measure of death risk—was 3.40 compared with 21–22.9. The association was more pronounced in younger adults. The excess risk associated with underweight was more prominent in women; the link with higher body mass index was steeper in men.
Why it matters
Aortic disease mortality raises a question about weight management across adulthood: whether maintaining body mass index within a healthy range is associated with lower death risk. The authors called for further studies to address that question.
Caveats
Illness present at the health check may have influenced both body mass index and later death risk, despite the exclusions and additional analyses. The cohort comprised Korean health-screening participants and excluded people diagnosed with aortic aneurysm or dissection in the preceding year.
From the paper
- Participants
A total of 15,146,946 individuals (mean age, 45.3±14.5 years; 54.4% male) were included in the analysis.
- Follow-up
Over a median follow-up of 14.3 years, 4,299 deaths from aortic disease were identified.
- Result
Underweight (BMI <18.5 kg/m: HR, 1.23; 95% CI, 1.04–1.45; p=0.013) and higher BMI categories, including upper-normal, overweight, and obese groups (e.g., BMI ≥35 kg/m: HR, 3.40; 95% CI, 2.10–5.49; p<0.001), were associated with increased mortality compared with BMI 21–22.9 kg/m.
Quoted word for word from the full text on e-kcj.org.
The paper
The Catholic University of Korea Seoul St. Mary's Hospital; Catholic Kwandong University
Korean Circulation Journal, Sep 7, 2026, Open access
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