Elevated body mass index (BMI) associates with cardiometabolic traits on observational analysis, yet the underlying causal relationships remain unclear. We conducted Mendelian randomization analyses by using a genetic score (GS) comprising 14 BMI-associated SNPs from a recent discovery analysis to investigate the causal role of BMI in cardiometabolic traits and events. We used eight population-based cohorts, including 34,538 European-descent individuals (4,407 type 2 diabetes (T2D), 6,073 coronary heart disease (CHD), and 3,813 stroke cases). A 1 kg/m2 genetically elevated BMI increased fasting glucose (0.18 mmol/l; 95% confidence interval (CI) = 0.12–0.24), fasting insulin (8.5%; 95% CI = 5.9–11.1), interleukin-6 (7.0%; 95% CI = 4.0–10.1), and systolic blood pressure (0.70 mmHg; 95% CI = 0.24–1.16) and reduced high-density lipoprotein cholesterol (−0.02 mmol/l; 95% CI = −0.03 to −0.01) and low-density lipoprotein cholesterol (LDL-C; −0.04 mmol/l; 95% CI = −0.07 to −0.01). Observational and causal estimates were directionally concordant, except for LDL-C. A 1 kg/m2 genetically elevated BMI increased the odds of T2D (odds ratio [OR] = 1.27; 95% CI = 1.18–1.36) but did not alter risk of CHD (OR 1.01; 95% CI = 0.94–1.08) or stroke (OR = 1.03; 95% CI = 0.95–1.12). A meta-analysis incorporating published studies reporting 27,465 CHD events in 219,423 individuals yielded a pooled OR of 1.04 (95% CI = 0.97–1.12) per 1 kg/m2 increase in BMI. In conclusion, we identified causal effects of BMI on several cardiometabolic traits; however, whether BMI causally impacts CHD risk requires further evidence.
