Short stature increases heart disease risk

by Todd Neale

People of short stature appear to have a heightened risk of adverse cardiovascular outcomes compared with their taller counterparts, according to a new meta-analysis.

Among 22 studies analyzed, the shortest people had a 1.46-fold greater risk of coronary heart disease or death, Tuula Paajanen, MD, of the University of Tampere in Finland, and colleagues reported online in the European Heart Journal.

A critical height cutoff point for increased risk could not be established because of methodological differences between the studies.

Nevertheless, the researchers wrote, “the relationship between short stature and cardiovascular disease seems to be a real one.”

In an accompanying editorial, Jaakko Tuomilehto, MD, PhD, of the University of Helsinki, said information on height can be used for the prevention of coronary heart disease and other chronic diseases linked to short stature.

“Full-term babies who are born small are likely to be short as adults. They should receive preventive attention early on,” he said. “The primordial prevention of chronic diseases should start during fetal life, and health promotion should be targeted to all pregnant women with the aim of healthy development of the fetus.”

It is not as easy to identify ways to prevent coronary heart disease in short adults, he said, although “it is likely that they would benefit from more aggressive risk factor reduction.”

“On the other hand, tall people are not protected against coronary heart disease, and they also need to pay attention to the same risk factors as shorter people,” Tuomilehto cautioned.

Many studies have examined the link between shorter height and cardiovascular disease, with mixed results. A systematic meta-analysis had not been performed.

So Paajanen’s group performed a literature search and identified 52 studies in which height and some coronary heart disease endpoint was measured. The studies included a 3,012,747 individuals.

Risk ratios could be extracted from 22 of the studies for the meta-analysis.

Although definitions for short and tall varied by study, the average cutoff for short was about 5 inches lower than that for tall (about 5’3″ versus 5’8″).

Outcomes included a diagnosis of angina pectoris, ischemic heart disease, or heart disease without myocardial infarction, acute MI, or history of MI, coronary artery occlusion of at least 50%, revascularization, or percutaneous transluminal coronary angioplasty, as well as all-cause mortality, cardiovascular disease mortality, or coronary heart disease mortality.

Individuals who fell into the shortest height category had increased risks of the following endpoints (with risk ratios):

* All-cause mortality: RR 1.35 (95% CI 1.25 to 1.44)
* Cardiovascular disease mortality: RR 1.55 (95% CI 1.37 to 1.74)
* Coronary heart disease mortality and morbidity combined: RR 1.49 (95% CI 1.33 to 1.67)
* Myocardial infarction: RR 1.52 (95% CI 1.28 to 1.81)

The associations were consistent for both men and women.

Among the 30 studies that could not be included in the meta-analysis, findings generally indicated an inverse relationship between height and risk of various adverse cardiovascular outcomes.

Reasons for the association between short stature and coronary heart disease are unclear, Paajanen and colleagues said.

“Most commonly, in previous studies it has been suggested that the reason behind this association could be low socioeconomic background with associated risk factors such as poor nutrition and infections resulting in poor fetal or early-life growth,” they wrote.

Another possibility is that smaller people have smaller coronary arteries that may become occluded earlier in life, they said.

The authors noted that the meta-analysis was primarily limited by the possibility of missing studies and by “different kinds of biases and confounding factors inherent to the original studies.”

Todd Neale is a MedPage Today staff writer.

Originally published in MedPage Today. Visit for more cardiology news.