# Impact of body mass index on aortic valve stenosis and its clinical outcomes in early adulthood: a long-term study of young men

## TL;DR

This study shows that higher body mass index in young men increases the risk of developing aortic valve stenosis and worsens outcomes later in life.

## Contribution

The study reveals a novel link between adolescent BMI and long-term risk of aortic valve stenosis and its clinical outcomes.

## Key findings

- Low BMI in adolescence is associated with reduced risk of aortic valve stenosis in early adulthood.
- Higher BMI in youth increases the risk of aortic valve stenosis and leads to worse survival and cardiovascular outcomes.
- Obese individuals with aortic valve stenosis face significantly higher mortality and heart failure risks.

## Abstract

We investigated associations between body mass index (BMI) in adolescence with development of aortic valve stenosis (AVS) in early adulthood, and clinical outcomes among those who develop AVS. We used data from 1 701 390 men (mean age, 18.3 ± 0.8 years) enrolled in compulsory conscription for military service in Sweden from 1969 to 2005. Anthropometrics, blood pressure, fitness, muscle strength and IQ were recorded at baseline. Over a median follow-up of 32 years (IQR, 24–41 years), 5766 men were diagnosed with AVS (mean age 54.7 ± 9.4 years). After multivariable adjustment, individuals with a BMI of < 18.5 kg/m2, compared to those with a low-normal BMI (20.0–<22.5 kg/m2) showed lower risk (HR 0.70; 95% CI 0.61–0.80) of AVS. Higher BMI categories were progressively associated with increased risk, reaching HR 1.91 (95% CI 1.12–3.25) for BMI 35–50 kg/m². Further on, those diagnosed with AVS were followed for a median of ~ 5.5 years. The multivariable-adjusted HR for all-cause mortality, cardiovascular mortality, and heart failure for obese (BMI 30–50 kg/m2), compared to BMI < 20.0 kg/m2 in men diagnosed with AVS, were 4.69 (95% CI 2.61–8.44), 4.09 (95% CI 1.72–9.73), and 2.76 (95% CI, 1.36–5.60), respectively. Higher BMI in youth, even within the conventional normal range, is associated with an elevated risk of developing AVS in early adulthood, whereas low BMI appears protective. Long-term exposure of obesity in individuals with AVS is associated with worse survival and higher risk of cardiovascular events.

The online version contains supplementary material available at 10.1038/s41598-026-44041-2.