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Adiposity as a cause of cardiovascular disease: a Mendelian randomization study

Identifieur interne : 000194 ( Pmc/Corpus ); précédent : 000193; suivant : 000195

Adiposity as a cause of cardiovascular disease: a Mendelian randomization study

Auteurs : Sara H Gg ; Tove Fall ; Alexander Ploner ; Reedik M Gi ; Krista Fischer ; Harmen Hm Draisma ; Mart Kals ; Paul S. De Vries ; Abbas Dehghan ; Sara M. Willems ; Antti-Pekka Sarin ; Kati Kristiansson ; Marja-Liisa Nuotio ; Aki S. Havulinna ; Renée Fag De Bruijn ; M Arfan Ikram ; Maris Kuningas ; Bruno H. Stricker ; Oscar H. Franco ; Beben Benyamin ; Christian Gieger ; Alistair S. Hall ; Ville Huikari ; Antti Jula ; Marjo-Riitta J Rvelin ; Marika Kaakinen ; Jaakko Kaprio ; Michael Kobl ; Massimo Mangino ; Christopher P. Nelson ; Aarno Palotie ; Nilesh J. Samani ; Tim D. Spector ; David P. Strachan ; Martin D. Tobin ; John B. Whitfield ; André G. Uitterlinden ; Veikko Salomaa ; Ann-Christine Syv Nen ; Kari Kuulasmaa ; Patrik K. Magnusson ; T Nu Esko ; Albert Hofman ; Eco Jc De Geus ; Lars Lind ; Vilmantas Giedraitis ; Markus Perola ; Alun Evans ; Jean Ferrières ; Jarmo Virtamo ; Frank Kee ; David-Alexandre Tregouet ; Dominique Arveiler ; Philippe Amouyel ; Francesco Gianfagna ; Paolo Brambilla ; Samuli Ripatti ; Cornelia M. Van Duijn ; Andres Metspalu ; Inga Prokopenko ; Mark I. Mccarthy ; Nancy L. Pedersen ; Erik Ingelsson

Source :

RBID : PMC:4553708

Abstract

Background: Adiposity, as indicated by body mass index (BMI), has been associated with risk of cardiovascular diseases in epidemiological studies. We aimed to investigate if these associations are causal, using Mendelian randomization (MR) methods.

Methods: The associations of BMI with cardiovascular outcomes [coronary heart disease (CHD), heart failure and ischaemic stroke], and associations of a genetic score (32 BMI single nucleotide polymorphisms) with BMI and cardiovascular outcomes were examined in up to 22 193 individuals with 3062 incident cardiovascular events from nine prospective follow-up studies within the ENGAGE consortium. We used random-effects meta-analysis in an MR framework to provide causal estimates of the effect of adiposity on cardiovascular outcomes.

Results: There was a strong association between BMI and incident CHD (HR = 1.20 per SD-increase of BMI, 95% CI, 1.12–1.28, P = 1.9·10−7), heart failure (HR = 1.47, 95% CI, 1.35–1.60, P = 9·10−19) and ischaemic stroke (HR = 1.15, 95% CI, 1.06–1.24, P = 0.0008) in observational analyses. The genetic score was robustly associated with BMI (β = 0.030 SD-increase of BMI per additional allele, 95% CI, 0.028–0.033, P = 3·10−107). Analyses indicated a causal effect of adiposity on development of heart failure (HR = 1.93 per SD-increase of BMI, 95% CI, 1.12–3.30, P = 0.017) and ischaemic stroke (HR = 1.83, 95% CI, 1.05–3.20, P = 0.034). Additional cross-sectional analyses using both ENGAGE and CARDIoGRAMplusC4D data showed a causal effect of adiposity on CHD.

Conclusions: Using MR methods, we provide support for the hypothesis that adiposity causes CHD, heart failure and, previously not demonstrated, ischaemic stroke.


Url:
DOI: 10.1093/ije/dyv094
PubMed: 26016847
PubMed Central: 4553708

Links to Exploration step

PMC:4553708

Le document en format XML

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<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
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<nlm:aff id="dyv094-AFF1">Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
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<name sortKey="Fall, Tove" sort="Fall, Tove" uniqKey="Fall T" first="Tove" last="Fall">Tove Fall</name>
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<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
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<nlm:aff id="dyv094-AFF1">Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
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<name sortKey="Ploner, Alexander" sort="Ploner, Alexander" uniqKey="Ploner A" first="Alexander" last="Ploner">Alexander Ploner</name>
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<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
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<name sortKey="M Gi, Reedik" sort="M Gi, Reedik" uniqKey="M Gi R" first="Reedik" last="M Gi">Reedik M Gi</name>
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<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
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<name sortKey="Fischer, Krista" sort="Fischer, Krista" uniqKey="Fischer K" first="Krista" last="Fischer">Krista Fischer</name>
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<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
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<name sortKey="Draisma, Harmen Hm" sort="Draisma, Harmen Hm" uniqKey="Draisma H" first="Harmen Hm" last="Draisma">Harmen Hm Draisma</name>
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<nlm:aff id="dyv094-AFF1">Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,</nlm:aff>
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<nlm:aff id="dyv094-AFF1">EMGO Institute for Health and Care Research, Amsterdam, The Netherlands,</nlm:aff>
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<name sortKey="Kals, Mart" sort="Kals, Mart" uniqKey="Kals M" first="Mart" last="Kals">Mart Kals</name>
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<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
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<nlm:aff id="dyv094-AFF1">Institute of Mathematical Statistics, University of Tartu, Tartu, Estonia,</nlm:aff>
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<name sortKey="De Vries, Paul S" sort="De Vries, Paul S" uniqKey="De Vries P" first="Paul S" last="De Vries">Paul S. De Vries</name>
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<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
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<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
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<name sortKey="Dehghan, Abbas" sort="Dehghan, Abbas" uniqKey="Dehghan A" first="Abbas" last="Dehghan">Abbas Dehghan</name>
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<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
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<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
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<name sortKey="Willems, Sara M" sort="Willems, Sara M" uniqKey="Willems S" first="Sara M" last="Willems">Sara M. Willems</name>
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<nlm:aff id="dyv094-AFF1">Department of Genetic Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Sarin, Antti Pekka" sort="Sarin, Antti Pekka" uniqKey="Sarin A" first="Antti-Pekka" last="Sarin">Antti-Pekka Sarin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kristiansson, Kati" sort="Kristiansson, Kati" uniqKey="Kristiansson K" first="Kati" last="Kristiansson">Kati Kristiansson</name>
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<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
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<author>
<name sortKey="Nuotio, Marja Liisa" sort="Nuotio, Marja Liisa" uniqKey="Nuotio M" first="Marja-Liisa" last="Nuotio">Marja-Liisa Nuotio</name>
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<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
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<author>
<name sortKey="Havulinna, Aki S" sort="Havulinna, Aki S" uniqKey="Havulinna A" first="Aki S" last="Havulinna">Aki S. Havulinna</name>
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<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
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<author>
<name sortKey="De Bruijn, Renee Fag" sort="De Bruijn, Renee Fag" uniqKey="De Bruijn R" first="Renée Fag" last="De Bruijn">Renée Fag De Bruijn</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=", and" id="dyv094-AFF1">Department of Neurology</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ikram, M Arfan" sort="Ikram, M Arfan" uniqKey="Ikram M" first="M Arfan" last="Ikram">M Arfan Ikram</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=", and" id="dyv094-AFF1">Department of Neurology</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kuningas, Maris" sort="Kuningas, Maris" uniqKey="Kuningas M" first="Maris" last="Kuningas">Maris Kuningas</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Inspectorate for Health Care, The Hague, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Stricker, Bruno H" sort="Stricker, Bruno H" uniqKey="Stricker B" first="Bruno H" last="Stricker">Bruno H. Stricker</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Inspectorate for Health Care, The Hague, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Franco, Oscar H" sort="Franco, Oscar H" uniqKey="Franco O" first="Oscar H" last="Franco">Oscar H. Franco</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Benyamin, Beben" sort="Benyamin, Beben" uniqKey="Benyamin B" first="Beben" last="Benyamin">Beben Benyamin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Gieger, Christian" sort="Gieger, Christian" uniqKey="Gieger C" first="Christian" last="Gieger">Christian Gieger</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hall, Alistair S" sort="Hall, Alistair S" uniqKey="Hall A" first="Alistair S" last="Hall">Alistair S. Hall</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Division of Epidemiology, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Huikari, Ville" sort="Huikari, Ville" uniqKey="Huikari V" first="Ville" last="Huikari">Ville Huikari</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jula, Antti" sort="Jula, Antti" uniqKey="Jula A" first="Antti" last="Jula">Antti Jula</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="J Rvelin, Marjo Riitta" sort="J Rvelin, Marjo Riitta" uniqKey="J Rvelin M" first="Marjo-Riitta" last="J Rvelin">Marjo-Riitta J Rvelin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">MRC Health Protection Agency (HPE) Centre for Environment and Health, Imperial College London, London, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Unit of Primary Care, Oulu University Hospital, Oulu, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kaakinen, Marika" sort="Kaakinen, Marika" uniqKey="Kaakinen M" first="Marika" last="Kaakinen">Marika Kaakinen</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kaprio, Jaakko" sort="Kaprio, Jaakko" uniqKey="Kaprio J" first="Jaakko" last="Kaprio">Jaakko Kaprio</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Hjelt Institute, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kobl, Michael" sort="Kobl, Michael" uniqKey="Kobl M" first="Michael" last="Kobl">Michael Kobl</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mangino, Massimo" sort="Mangino, Massimo" uniqKey="Mangino M" first="Massimo" last="Mangino">Massimo Mangino</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Twin Research and Genetic Epidemiology, King's College London, London, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Nelson, Christopher P" sort="Nelson, Christopher P" uniqKey="Nelson C" first="Christopher P" last="Nelson">Christopher P. Nelson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health Research, Glenfield Hospital, Leicester, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Palotie, Aarno" sort="Palotie, Aarno" uniqKey="Palotie A" first="Aarno" last="Palotie">Aarno Palotie</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Broad Institute, Cambridge, MA, USA,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Samani, Nilesh J" sort="Samani, Nilesh J" uniqKey="Samani N" first="Nilesh J" last="Samani">Nilesh J. Samani</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health Research, Glenfield Hospital, Leicester, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Spector, Tim D" sort="Spector, Tim D" uniqKey="Spector T" first="Tim D" last="Spector">Tim D. Spector</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Twin Research and Genetic Epidemiology, King's College London, London, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Strachan, David P" sort="Strachan, David P" uniqKey="Strachan D" first="David P" last="Strachan">David P. Strachan</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">St George's, University of London, London, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Tobin, Martin D" sort="Tobin, Martin D" uniqKey="Tobin M" first="Martin D" last="Tobin">Martin D. Tobin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Health Sciences, University of Leicester, Leicester, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Whitfield, John B" sort="Whitfield, John B" uniqKey="Whitfield J" first="John B" last="Whitfield">John B. Whitfield</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Uitterlinden, Andre G" sort="Uitterlinden, Andre G" uniqKey="Uitterlinden A" first="André G" last="Uitterlinden">André G. Uitterlinden</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Salomaa, Veikko" sort="Salomaa, Veikko" uniqKey="Salomaa V" first="Veikko" last="Salomaa">Veikko Salomaa</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Syv Nen, Ann Christine" sort="Syv Nen, Ann Christine" uniqKey="Syv Nen A" first="Ann-Christine" last="Syv Nen">Ann-Christine Syv Nen</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kuulasmaa, Kari" sort="Kuulasmaa, Kari" uniqKey="Kuulasmaa K" first="Kari" last="Kuulasmaa">Kari Kuulasmaa</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Magnusson, Patrik K" sort="Magnusson, Patrik K" uniqKey="Magnusson P" first="Patrik K" last="Magnusson">Patrik K. Magnusson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Esko, T Nu" sort="Esko, T Nu" uniqKey="Esko T" first="T Nu" last="Esko">T Nu Esko</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Broad Institute, Cambridge, MA, USA,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Genetics, Harvard Medical School, Boston, MA, USA,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hofman, Albert" sort="Hofman, Albert" uniqKey="Hofman A" first="Albert" last="Hofman">Albert Hofman</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="De Geus, Eco Jc" sort="De Geus, Eco Jc" uniqKey="De Geus E" first="Eco Jc" last="De Geus">Eco Jc De Geus</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">EMGO Institute for Health and Care Research, Amsterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lind, Lars" sort="Lind, Lars" uniqKey="Lind L" first="Lars" last="Lind">Lars Lind</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Giedraitis, Vilmantas" sort="Giedraitis, Vilmantas" uniqKey="Giedraitis V" first="Vilmantas" last="Giedraitis">Vilmantas Giedraitis</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Public Health and Caring Sciences, Rudbeck Laboratory, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Perola, Markus" sort="Perola, Markus" uniqKey="Perola M" first="Markus" last="Perola">Markus Perola</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Evans, Alun" sort="Evans, Alun" uniqKey="Evans A" first="Alun" last="Evans">Alun Evans</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Centre for Public Health, Queen's University of Belfast, Belfast, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ferrieres, Jean" sort="Ferrieres, Jean" uniqKey="Ferrieres J" first="Jean" last="Ferrières">Jean Ferrières</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Virtamo, Jarmo" sort="Virtamo, Jarmo" uniqKey="Virtamo J" first="Jarmo" last="Virtamo">Jarmo Virtamo</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kee, Frank" sort="Kee, Frank" uniqKey="Kee F" first="Frank" last="Kee">Frank Kee</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University of Belfast, Belfast, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Tregouet, David Alexandre" sort="Tregouet, David Alexandre" uniqKey="Tregouet D" first="David-Alexandre" last="Tregouet">David-Alexandre Tregouet</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, UPMC Univ Paris 06, Paris, France,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Team Genomics & Pathophysiology of Cardiovascular Diseases, INSERM, UMR_S 1166, Paris, France,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">ICAN Institute for Cardiometabolism and Nutrition, Paris, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Arveiler, Dominique" sort="Arveiler, Dominique" uniqKey="Arveiler D" first="Dominique" last="Arveiler">Dominique Arveiler</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology and Public Health, University Hospital of Strasbourg, Strasbourg, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Amouyel, Philippe" sort="Amouyel, Philippe" uniqKey="Amouyel P" first="Philippe" last="Amouyel">Philippe Amouyel</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institut Pasteur de Lille, Université Lille Nord de France, Lille, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Gianfagna, Francesco" sort="Gianfagna, Francesco" uniqKey="Gianfagna F" first="Francesco" last="Gianfagna">Francesco Gianfagna</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Research Centre for Epidemiology and Preventive Medicine (EPIMED), Department of Clinical and Experimental Medicine, University of Insubria at Varese, Italy,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Brambilla, Paolo" sort="Brambilla, Paolo" uniqKey="Brambilla P" first="Paolo" last="Brambilla">Paolo Brambilla</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Experimental Medicine, University of Milano-Bicocca, Monza, Italy,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ripatti, Samuli" sort="Ripatti, Samuli" uniqKey="Ripatti S" first="Samuli" last="Ripatti">Samuli Ripatti</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Hjelt Institute, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Van Duijn, Cornelia M" sort="Van Duijn, Cornelia M" uniqKey="Van Duijn C" first="Cornelia M" last="Van Duijn">Cornelia M. Van Duijn</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Genomics Initiative, Leiden University Medical Center, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Metspalu, Andres" sort="Metspalu, Andres" uniqKey="Metspalu A" first="Andres" last="Metspalu">Andres Metspalu</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Prokopenko, Inga" sort="Prokopenko, Inga" uniqKey="Prokopenko I" first="Inga" last="Prokopenko">Inga Prokopenko</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=" and" id="dyv094-AFF1">Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mccarthy, Mark I" sort="Mccarthy, Mark I" uniqKey="Mccarthy M" first="Mark I" last="Mccarthy">Mark I. Mccarthy</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pedersen, Nancy L" sort="Pedersen, Nancy L" uniqKey="Pedersen N" first="Nancy L" last="Pedersen">Nancy L. Pedersen</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ingelsson, Erik" sort="Ingelsson, Erik" uniqKey="Ingelsson E" first="Erik" last="Ingelsson">Erik Ingelsson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
</author>
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<idno type="doi">10.1093/ije/dyv094</idno>
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<title xml:lang="en" level="a" type="main">Adiposity as a cause of cardiovascular disease: a Mendelian randomization study</title>
<author>
<name sortKey="H Gg, Sara" sort="H Gg, Sara" uniqKey="H Gg S" first="Sara" last="H Gg">Sara H Gg</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fall, Tove" sort="Fall, Tove" uniqKey="Fall T" first="Tove" last="Fall">Tove Fall</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ploner, Alexander" sort="Ploner, Alexander" uniqKey="Ploner A" first="Alexander" last="Ploner">Alexander Ploner</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="M Gi, Reedik" sort="M Gi, Reedik" uniqKey="M Gi R" first="Reedik" last="M Gi">Reedik M Gi</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fischer, Krista" sort="Fischer, Krista" uniqKey="Fischer K" first="Krista" last="Fischer">Krista Fischer</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Draisma, Harmen Hm" sort="Draisma, Harmen Hm" uniqKey="Draisma H" first="Harmen Hm" last="Draisma">Harmen Hm Draisma</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">EMGO Institute for Health and Care Research, Amsterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kals, Mart" sort="Kals, Mart" uniqKey="Kals M" first="Mart" last="Kals">Mart Kals</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Mathematical Statistics, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="De Vries, Paul S" sort="De Vries, Paul S" uniqKey="De Vries P" first="Paul S" last="De Vries">Paul S. De Vries</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dehghan, Abbas" sort="Dehghan, Abbas" uniqKey="Dehghan A" first="Abbas" last="Dehghan">Abbas Dehghan</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Willems, Sara M" sort="Willems, Sara M" uniqKey="Willems S" first="Sara M" last="Willems">Sara M. Willems</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Genetic Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Sarin, Antti Pekka" sort="Sarin, Antti Pekka" uniqKey="Sarin A" first="Antti-Pekka" last="Sarin">Antti-Pekka Sarin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kristiansson, Kati" sort="Kristiansson, Kati" uniqKey="Kristiansson K" first="Kati" last="Kristiansson">Kati Kristiansson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Nuotio, Marja Liisa" sort="Nuotio, Marja Liisa" uniqKey="Nuotio M" first="Marja-Liisa" last="Nuotio">Marja-Liisa Nuotio</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Havulinna, Aki S" sort="Havulinna, Aki S" uniqKey="Havulinna A" first="Aki S" last="Havulinna">Aki S. Havulinna</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="De Bruijn, Renee Fag" sort="De Bruijn, Renee Fag" uniqKey="De Bruijn R" first="Renée Fag" last="De Bruijn">Renée Fag De Bruijn</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=", and" id="dyv094-AFF1">Department of Neurology</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ikram, M Arfan" sort="Ikram, M Arfan" uniqKey="Ikram M" first="M Arfan" last="Ikram">M Arfan Ikram</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=", and" id="dyv094-AFF1">Department of Neurology</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kuningas, Maris" sort="Kuningas, Maris" uniqKey="Kuningas M" first="Maris" last="Kuningas">Maris Kuningas</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Inspectorate for Health Care, The Hague, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Stricker, Bruno H" sort="Stricker, Bruno H" uniqKey="Stricker B" first="Bruno H" last="Stricker">Bruno H. Stricker</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Inspectorate for Health Care, The Hague, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Franco, Oscar H" sort="Franco, Oscar H" uniqKey="Franco O" first="Oscar H" last="Franco">Oscar H. Franco</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Benyamin, Beben" sort="Benyamin, Beben" uniqKey="Benyamin B" first="Beben" last="Benyamin">Beben Benyamin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Gieger, Christian" sort="Gieger, Christian" uniqKey="Gieger C" first="Christian" last="Gieger">Christian Gieger</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hall, Alistair S" sort="Hall, Alistair S" uniqKey="Hall A" first="Alistair S" last="Hall">Alistair S. Hall</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Division of Epidemiology, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Huikari, Ville" sort="Huikari, Ville" uniqKey="Huikari V" first="Ville" last="Huikari">Ville Huikari</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jula, Antti" sort="Jula, Antti" uniqKey="Jula A" first="Antti" last="Jula">Antti Jula</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="J Rvelin, Marjo Riitta" sort="J Rvelin, Marjo Riitta" uniqKey="J Rvelin M" first="Marjo-Riitta" last="J Rvelin">Marjo-Riitta J Rvelin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">MRC Health Protection Agency (HPE) Centre for Environment and Health, Imperial College London, London, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Unit of Primary Care, Oulu University Hospital, Oulu, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kaakinen, Marika" sort="Kaakinen, Marika" uniqKey="Kaakinen M" first="Marika" last="Kaakinen">Marika Kaakinen</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kaprio, Jaakko" sort="Kaprio, Jaakko" uniqKey="Kaprio J" first="Jaakko" last="Kaprio">Jaakko Kaprio</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Hjelt Institute, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kobl, Michael" sort="Kobl, Michael" uniqKey="Kobl M" first="Michael" last="Kobl">Michael Kobl</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mangino, Massimo" sort="Mangino, Massimo" uniqKey="Mangino M" first="Massimo" last="Mangino">Massimo Mangino</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Twin Research and Genetic Epidemiology, King's College London, London, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Nelson, Christopher P" sort="Nelson, Christopher P" uniqKey="Nelson C" first="Christopher P" last="Nelson">Christopher P. Nelson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health Research, Glenfield Hospital, Leicester, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Palotie, Aarno" sort="Palotie, Aarno" uniqKey="Palotie A" first="Aarno" last="Palotie">Aarno Palotie</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Broad Institute, Cambridge, MA, USA,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Samani, Nilesh J" sort="Samani, Nilesh J" uniqKey="Samani N" first="Nilesh J" last="Samani">Nilesh J. Samani</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health Research, Glenfield Hospital, Leicester, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Spector, Tim D" sort="Spector, Tim D" uniqKey="Spector T" first="Tim D" last="Spector">Tim D. Spector</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Twin Research and Genetic Epidemiology, King's College London, London, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Strachan, David P" sort="Strachan, David P" uniqKey="Strachan D" first="David P" last="Strachan">David P. Strachan</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">St George's, University of London, London, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Tobin, Martin D" sort="Tobin, Martin D" uniqKey="Tobin M" first="Martin D" last="Tobin">Martin D. Tobin</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Health Sciences, University of Leicester, Leicester, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Whitfield, John B" sort="Whitfield, John B" uniqKey="Whitfield J" first="John B" last="Whitfield">John B. Whitfield</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Uitterlinden, Andre G" sort="Uitterlinden, Andre G" uniqKey="Uitterlinden A" first="André G" last="Uitterlinden">André G. Uitterlinden</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Salomaa, Veikko" sort="Salomaa, Veikko" uniqKey="Salomaa V" first="Veikko" last="Salomaa">Veikko Salomaa</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Syv Nen, Ann Christine" sort="Syv Nen, Ann Christine" uniqKey="Syv Nen A" first="Ann-Christine" last="Syv Nen">Ann-Christine Syv Nen</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kuulasmaa, Kari" sort="Kuulasmaa, Kari" uniqKey="Kuulasmaa K" first="Kari" last="Kuulasmaa">Kari Kuulasmaa</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Magnusson, Patrik K" sort="Magnusson, Patrik K" uniqKey="Magnusson P" first="Patrik K" last="Magnusson">Patrik K. Magnusson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Esko, T Nu" sort="Esko, T Nu" uniqKey="Esko T" first="T Nu" last="Esko">T Nu Esko</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Broad Institute, Cambridge, MA, USA,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Genetics, Harvard Medical School, Boston, MA, USA,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hofman, Albert" sort="Hofman, Albert" uniqKey="Hofman A" first="Albert" last="Hofman">Albert Hofman</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="De Geus, Eco Jc" sort="De Geus, Eco Jc" uniqKey="De Geus E" first="Eco Jc" last="De Geus">Eco Jc De Geus</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">EMGO Institute for Health and Care Research, Amsterdam, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lind, Lars" sort="Lind, Lars" uniqKey="Lind L" first="Lars" last="Lind">Lars Lind</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Giedraitis, Vilmantas" sort="Giedraitis, Vilmantas" uniqKey="Giedraitis V" first="Vilmantas" last="Giedraitis">Vilmantas Giedraitis</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Public Health and Caring Sciences, Rudbeck Laboratory, Uppsala, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Perola, Markus" sort="Perola, Markus" uniqKey="Perola M" first="Markus" last="Perola">Markus Perola</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Evans, Alun" sort="Evans, Alun" uniqKey="Evans A" first="Alun" last="Evans">Alun Evans</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Centre for Public Health, Queen's University of Belfast, Belfast, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ferrieres, Jean" sort="Ferrieres, Jean" uniqKey="Ferrieres J" first="Jean" last="Ferrières">Jean Ferrières</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Virtamo, Jarmo" sort="Virtamo, Jarmo" uniqKey="Virtamo J" first="Jarmo" last="Virtamo">Jarmo Virtamo</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kee, Frank" sort="Kee, Frank" uniqKey="Kee F" first="Frank" last="Kee">Frank Kee</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University of Belfast, Belfast, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Tregouet, David Alexandre" sort="Tregouet, David Alexandre" uniqKey="Tregouet D" first="David-Alexandre" last="Tregouet">David-Alexandre Tregouet</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, UPMC Univ Paris 06, Paris, France,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Team Genomics & Pathophysiology of Cardiovascular Diseases, INSERM, UMR_S 1166, Paris, France,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">ICAN Institute for Cardiometabolism and Nutrition, Paris, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Arveiler, Dominique" sort="Arveiler, Dominique" uniqKey="Arveiler D" first="Dominique" last="Arveiler">Dominique Arveiler</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology and Public Health, University Hospital of Strasbourg, Strasbourg, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Amouyel, Philippe" sort="Amouyel, Philippe" uniqKey="Amouyel P" first="Philippe" last="Amouyel">Philippe Amouyel</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institut Pasteur de Lille, Université Lille Nord de France, Lille, France,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Gianfagna, Francesco" sort="Gianfagna, Francesco" uniqKey="Gianfagna F" first="Francesco" last="Gianfagna">Francesco Gianfagna</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Research Centre for Epidemiology and Preventive Medicine (EPIMED), Department of Clinical and Experimental Medicine, University of Insubria at Varese, Italy,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Brambilla, Paolo" sort="Brambilla, Paolo" uniqKey="Brambilla P" first="Paolo" last="Brambilla">Paolo Brambilla</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Experimental Medicine, University of Milano-Bicocca, Monza, Italy,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ripatti, Samuli" sort="Ripatti, Samuli" uniqKey="Ripatti S" first="Samuli" last="Ripatti">Samuli Ripatti</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">National Institute for Health and Welfare, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Hjelt Institute, University of Helsinki, Helsinki, Finland,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Van Duijn, Cornelia M" sort="Van Duijn, Cornelia M" uniqKey="Van Duijn C" first="Cornelia M" last="Van Duijn">Cornelia M. Van Duijn</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Netherlands Genomics Initiative, Leiden University Medical Center, Leiden, The Netherlands,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Metspalu, Andres" sort="Metspalu, Andres" uniqKey="Metspalu A" first="Andres" last="Metspalu">Andres Metspalu</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Estonian Genome Center, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Prokopenko, Inga" sort="Prokopenko, Inga" uniqKey="Prokopenko I" first="Inga" last="Prokopenko">Inga Prokopenko</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=" and" id="dyv094-AFF1">Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mccarthy, Mark I" sort="Mccarthy, Mark I" uniqKey="Mccarthy M" first="Mark I" last="Mccarthy">Mark I. Mccarthy</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pedersen, Nancy L" sort="Pedersen, Nancy L" uniqKey="Pedersen N" first="Nancy L" last="Pedersen">Nancy L. Pedersen</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ingelsson, Erik" sort="Ingelsson, Erik" uniqKey="Ingelsson E" first="Erik" last="Ingelsson">Erik Ingelsson</name>
<affiliation>
<nlm:aff id="dyv094-AFF1">Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="dyv094-AFF1">Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">International Journal of Epidemiology</title>
<idno type="ISSN">0300-5771</idno>
<idno type="eISSN">1464-3685</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>
<bold>Background:</bold>
Adiposity, as indicated by body mass index (BMI), has been associated with risk of cardiovascular diseases in epidemiological studies. We aimed to investigate if these associations are causal, using Mendelian randomization (MR) methods.</p>
<p>
<bold>Methods:</bold>
The associations of BMI with cardiovascular outcomes [coronary heart disease (CHD), heart failure and ischaemic stroke], and associations of a genetic score (32 BMI single nucleotide polymorphisms) with BMI and cardiovascular outcomes were examined in up to 22 193 individuals with 3062 incident cardiovascular events from nine prospective follow-up studies within the ENGAGE consortium. We used random-effects meta-analysis in an MR framework to provide causal estimates of the effect of adiposity on cardiovascular outcomes.</p>
<p>
<bold>Results:</bold>
There was a strong association between BMI and incident CHD (HR = 1.20 per SD-increase of BMI, 95% CI, 1.12–1.28, P = 1.9·10
<sup>−7</sup>
), heart failure (HR = 1.47, 95% CI, 1.35–1.60, P = 9·10
<sup>−19</sup>
) and ischaemic stroke (HR = 1.15, 95% CI, 1.06–1.24, P = 0.0008) in observational analyses. The genetic score was robustly associated with BMI (β = 0.030 SD-increase of BMI per additional allele, 95% CI, 0.028–0.033, P = 3·10
<sup>−107</sup>
). Analyses indicated a causal effect of adiposity on development of heart failure (HR = 1.93 per SD-increase of BMI, 95% CI, 1.12–3.30, P = 0.017) and ischaemic stroke (HR = 1.83, 95% CI, 1.05–3.20, P = 0.034). Additional cross-sectional analyses using both ENGAGE and CARDIoGRAMplusC4D data showed a causal effect of adiposity on CHD.</p>
<p>
<bold>Conclusions:</bold>
Using MR methods, we provide support for the hypothesis that adiposity causes CHD, heart failure and, previously not demonstrated, ischaemic stroke.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article">
<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Int J Epidemiol</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Epidemiol</journal-id>
<journal-id journal-id-type="publisher-id">ije</journal-id>
<journal-id journal-id-type="hwp">intjepid</journal-id>
<journal-title-group>
<journal-title>International Journal of Epidemiology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0300-5771</issn>
<issn pub-type="epub">1464-3685</issn>
<publisher>
<publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">26016847</article-id>
<article-id pub-id-type="pmc">4553708</article-id>
<article-id pub-id-type="doi">10.1093/ije/dyv094</article-id>
<article-id pub-id-type="publisher-id">dyv094</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Mendelian Randomization Causal Analysis</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Adiposity as a cause of cardiovascular disease: a Mendelian randomization study</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Hägg</surname>
<given-names>Sara</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="dyv094-FN1">
<sup></sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fall</surname>
<given-names>Tove</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="dyv094-FN1">
<sup></sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ploner</surname>
<given-names>Alexander</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mägi</surname>
<given-names>Reedik</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fischer</surname>
<given-names>Krista</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Draisma</surname>
<given-names>Harmen HM</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kals</surname>
<given-names>Mart</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>de Vries</surname>
<given-names>Paul S</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dehghan</surname>
<given-names>Abbas</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Willems</surname>
<given-names>Sara M</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sarin</surname>
<given-names>Antti-Pekka</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>10</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kristiansson</surname>
<given-names>Kati</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nuotio</surname>
<given-names>Marja-Liisa</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Havulinna</surname>
<given-names>Aki S</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>de Bruijn</surname>
<given-names>Renée FAG</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>12</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ikram</surname>
<given-names>M Arfan</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>12</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>13</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kuningas</surname>
<given-names>Maris</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>14</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Stricker</surname>
<given-names>Bruno H</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>14</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Franco</surname>
<given-names>Oscar H</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Benyamin</surname>
<given-names>Beben</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>15</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>16</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Gieger</surname>
<given-names>Christian</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>17</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hall</surname>
<given-names>Alistair S</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>18</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Huikari</surname>
<given-names>Ville</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>19</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jula</surname>
<given-names>Antti</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>20</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Järvelin</surname>
<given-names>Marjo-Riitta</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>19</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>21</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>22</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>23</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kaakinen</surname>
<given-names>Marika</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>19</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kaprio</surname>
<given-names>Jaakko</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>10</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>24</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kobl</surname>
<given-names>Michael</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>17</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mangino</surname>
<given-names>Massimo</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>25</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nelson</surname>
<given-names>Christopher P</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>26</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>27</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Palotie</surname>
<given-names>Aarno</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>10</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>28</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>29</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Samani</surname>
<given-names>Nilesh J</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>26</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>27</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Spector</surname>
<given-names>Tim D</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>25</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Strachan</surname>
<given-names>David P</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>30</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tobin</surname>
<given-names>Martin D</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>31</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Whitfield</surname>
<given-names>John B</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>16</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Uitterlinden</surname>
<given-names>André G</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>8</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>32</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Salomaa</surname>
<given-names>Veikko</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Syvänen</surname>
<given-names>Ann-Christine</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>33</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kuulasmaa</surname>
<given-names>Kari</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Magnusson</surname>
<given-names>Patrik K</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Esko</surname>
<given-names>Tõnu</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>28</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>34</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>35</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hofman</surname>
<given-names>Albert</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>de Geus</surname>
<given-names>Eco JC</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lind</surname>
<given-names>Lars</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>36</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Giedraitis</surname>
<given-names>Vilmantas</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>37</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Perola</surname>
<given-names>Markus</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>10</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Evans</surname>
<given-names>Alun</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>38</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ferrières</surname>
<given-names>Jean</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>39</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Virtamo</surname>
<given-names>Jarmo</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kee</surname>
<given-names>Frank</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>40</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tregouet</surname>
<given-names>David-Alexandre</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>41</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>42</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>43</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Arveiler</surname>
<given-names>Dominique</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>44</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Amouyel</surname>
<given-names>Philippe</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>45</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Gianfagna</surname>
<given-names>Francesco</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>46</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>47</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Brambilla</surname>
<given-names>Paolo</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>48</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ripatti</surname>
<given-names>Samuli</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>10</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>11</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>24</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>49</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>van Duijn</surname>
<given-names>Cornelia M</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>8</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>50</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Metspalu</surname>
<given-names>Andres</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>51</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Prokopenko</surname>
<given-names>Inga</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>49</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>52</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>53</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>McCarthy</surname>
<given-names>Mark I</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>49</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>52</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>54</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pedersen</surname>
<given-names>Nancy L</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ingelsson</surname>
<given-names>Erik</given-names>
</name>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyv094-AFF1">
<sup>49</sup>
</xref>
<xref ref-type="corresp" rid="dyv094-COR1">*</xref>
</contrib>
<contrib contrib-type="author">
<collab>for the European Network for Genetic and Genomic Epidemiology (ENGAGE) consortium</collab>
</contrib>
<aff id="dyv094-AFF1">
<sup>1</sup>
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
<sup>2</sup>
Molecular Epidemiology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,
<sup>3</sup>
Estonian Genome Center, University of Tartu, Tartu, Estonia,
<sup>4</sup>
Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,
<sup>5</sup>
EMGO Institute for Health and Care Research, Amsterdam, The Netherlands,
<sup>6</sup>
Institute of Mathematical Statistics, University of Tartu, Tartu, Estonia,
<sup>7</sup>
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,
<sup>8</sup>
Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, Leiden, The Netherlands,
<sup>9</sup>
Department of Genetic Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands,
<sup>10</sup>
Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland,
<sup>11</sup>
National Institute for Health and Welfare, Helsinki, Finland,
<sup>12</sup>
Department of Neurology, and
<sup>13</sup>
Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands,
<sup>14</sup>
Inspectorate for Health Care, The Hague, The Netherlands,
<sup>15</sup>
Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia,
<sup>16</sup>
QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,
<sup>17</sup>
Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany,
<sup>18</sup>
Division of Epidemiology, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK,
<sup>19</sup>
Center for Life Course and Systems Epidemiology, University of Oulu, Oulu, Finland,
<sup>20</sup>
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland,
<sup>21</sup>
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland,
<sup>22</sup>
MRC Health Protection Agency (HPE) Centre for Environment and Health, Imperial College London, London, UK,
<sup>23</sup>
Unit of Primary Care, Oulu University Hospital, Oulu, Finland,
<sup>24</sup>
Hjelt Institute, University of Helsinki, Helsinki, Finland,
<sup>25</sup>
Department of Twin Research and Genetic Epidemiology, King's College London, London, UK,
<sup>26</sup>
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,
<sup>27</sup>
National Institute for Health Research, Glenfield Hospital, Leicester, UK,
<sup>28</sup>
Broad Institute, Cambridge, MA, USA,
<sup>29</sup>
Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland,
<sup>30</sup>
St George's, University of London, London, UK,
<sup>31</sup>
Department of Health Sciences, University of Leicester, Leicester, UK,
<sup>32</sup>
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands,
<sup>33</sup>
Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden,
<sup>34</sup>
Department of Genetics, Harvard Medical School, Boston, MA, USA,
<sup>35</sup>
Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA,
<sup>36</sup>
Department of Medical Sciences, Uppsala University, Uppsala, Sweden,
<sup>37</sup>
Department of Public Health and Caring Sciences, Rudbeck Laboratory, Uppsala, Sweden,
<sup>38</sup>
Centre for Public Health, Queen's University of Belfast, Belfast, UK,
<sup>39</sup>
Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France,
<sup>40</sup>
UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University of Belfast, Belfast, UK,
<sup>41</sup>
Team Genomics & Pathophysiology of Cardiovascular Diseases, Sorbonne Universités, UPMC Univ Paris 06, Paris, France,
<sup>42</sup>
Team Genomics & Pathophysiology of Cardiovascular Diseases, INSERM, UMR_S 1166, Paris, France,
<sup>43</sup>
ICAN Institute for Cardiometabolism and Nutrition, Paris, France,
<sup>44</sup>
Department of Epidemiology and Public Health, University Hospital of Strasbourg, Strasbourg, France,
<sup>45</sup>
Institut Pasteur de Lille, Université Lille Nord de France, Lille, France,
<sup>46</sup>
Research Centre for Epidemiology and Preventive Medicine (EPIMED), Department of Clinical and Experimental Medicine, University of Insubria at Varese, Italy,
<sup>47</sup>
Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy,
<sup>48</sup>
Department of Experimental Medicine, University of Milano-Bicocca, Monza, Italy,
<sup>49</sup>
Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,
<sup>50</sup>
Netherlands Genomics Initiative, Leiden University Medical Center, Leiden, The Netherlands,
<sup>51</sup>
Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia,
<sup>52</sup>
Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK,
<sup>53</sup>
Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, UK and
<sup>54</sup>
Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK</aff>
</contrib-group>
<author-notes>
<corresp id="dyv094-COR1">*Corresponding author. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Box 1115, SE-751 85 Uppsala, Sweden. E-mail:
<email>erik.ingelsson@medsci.uu.se</email>
</corresp>
<fn id="dyv094-FN1">
<p>
<sup></sup>
These authors contributed equally to this work.</p>
</fn>
</author-notes>
<pub-date pub-type="ppub">
<month>4</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub">
<day>26</day>
<month>5</month>
<year>2015</year>
</pub-date>
<volume>44</volume>
<issue>2</issue>
<fpage>578</fpage>
<lpage>586</lpage>
<history>
<date date-type="accepted">
<day>05</day>
<month>5</month>
<year>2015</year>
</date>
</history>
<permissions>
<copyright-statement>© The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association</copyright-statement>
<copyright-year>2015</copyright-year>
</permissions>
<abstract>
<p>
<bold>Background:</bold>
Adiposity, as indicated by body mass index (BMI), has been associated with risk of cardiovascular diseases in epidemiological studies. We aimed to investigate if these associations are causal, using Mendelian randomization (MR) methods.</p>
<p>
<bold>Methods:</bold>
The associations of BMI with cardiovascular outcomes [coronary heart disease (CHD), heart failure and ischaemic stroke], and associations of a genetic score (32 BMI single nucleotide polymorphisms) with BMI and cardiovascular outcomes were examined in up to 22 193 individuals with 3062 incident cardiovascular events from nine prospective follow-up studies within the ENGAGE consortium. We used random-effects meta-analysis in an MR framework to provide causal estimates of the effect of adiposity on cardiovascular outcomes.</p>
<p>
<bold>Results:</bold>
There was a strong association between BMI and incident CHD (HR = 1.20 per SD-increase of BMI, 95% CI, 1.12–1.28, P = 1.9·10
<sup>−7</sup>
), heart failure (HR = 1.47, 95% CI, 1.35–1.60, P = 9·10
<sup>−19</sup>
) and ischaemic stroke (HR = 1.15, 95% CI, 1.06–1.24, P = 0.0008) in observational analyses. The genetic score was robustly associated with BMI (β = 0.030 SD-increase of BMI per additional allele, 95% CI, 0.028–0.033, P = 3·10
<sup>−107</sup>
). Analyses indicated a causal effect of adiposity on development of heart failure (HR = 1.93 per SD-increase of BMI, 95% CI, 1.12–3.30, P = 0.017) and ischaemic stroke (HR = 1.83, 95% CI, 1.05–3.20, P = 0.034). Additional cross-sectional analyses using both ENGAGE and CARDIoGRAMplusC4D data showed a causal effect of adiposity on CHD.</p>
<p>
<bold>Conclusions:</bold>
Using MR methods, we provide support for the hypothesis that adiposity causes CHD, heart failure and, previously not demonstrated, ischaemic stroke.</p>
</abstract>
<kwd-group>
<kwd>Cardiovascular disease</kwd>
<kwd>epidemiology</kwd>
<kwd>body mass index</kwd>
<kwd>Mendelian randomization</kwd>
</kwd-group>
<counts>
<page-count count="9"></page-count>
</counts>
</article-meta>
</front>
</pmc>
</record>

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