Body mass index, waist circumference, and risk of coronary heart disease: A prospective study among men and women.

SUMMARY OBJECTIVE The purpose of the study was to assess the risk of CHD associated with excess weight measured by BMI and waist circumference (WC) in two large cohorts of men and women. DESIGN, SETTING, SUBJECTS Participants in two prospective cohort studies, the Health Professionals Follow-up Study (N = 27,859 men; age range 39-75 years) and the Nurses' Health Study (N = 41,534 women; 39-65 years) underwent 16-year follow-up through 2004. RESULTS 1823 incident cases of CHD among men and 1173 cases among women were documented. Compared to men with BMI 18.5-22.9 kg/m(2), those with a BMI > 30.0 kg/m(2) had a multivariate-adjusted RR of CHD of 1.81 (95% CI 1.48-2.22). Among women, those with a BMI > 30.0 kg/m(2) had a RR of CHD of 2.16 (95% CI 1.81-2.58). Compared to men with a WC < 84.0 cm, those with WC of greater than 102.0 cm had a RR of 2.25 (95% CI 1.77-2.84). Among women, the RR of CHD was 2.75 (95% CI 2.20-3.45) for those with WC of greater than 88.0 cm. CONCLUSIONS In these analyses from two large ongoing prospective cohort studies, both BMI and WC strongly predicted future risk of CHD. Furthermore, WC thresholds as low as 84.0 cm in men and 71.0 cm in women may be useful in identifying those at increased risk of developing CHD. The findings have broad implications in terms of CHD risk assessment in both clinical practice and epidemiologic studies.

[1]  M. Gail,et al.  Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial , 2005, Gynecologic oncology.

[2]  Chaoyang Li,et al.  Increasing Trends in Waist Circumference and Abdominal Obesity among U.S. Adults , 2007, Obesity.

[3]  D E Grobbee,et al.  Coffee, caffeine, and cardiovascular disease in men. , 1990, The New England journal of medicine.

[4]  R. Ross,et al.  Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. , 2002, The American journal of clinical nutrition.

[5]  Elisa T. Lee,et al.  Statistical Methods for Survival Data Analysis , 1994, IEEE Transactions on Reliability.

[6]  S. Bowlin,et al.  Validity of cardiovascular disease risk factors assessed by telephone survey: the Behavioral Risk Factor Survey. , 1993, Journal of clinical epidemiology.

[7]  J. Manson,et al.  Obesity, Diabetes, and Coronary Risk in Women , 2002, Journal of cardiovascular risk.

[8]  Leonard H. Epstein,et al.  Overweight, obesity, and health risk. , 2000, Archives of internal medicine.

[9]  T. Welborn,et al.  Waist–hip ratio is the dominant risk factor predicting cardiovascular death in Australia , 2003, The Medical journal of Australia.

[10]  M. Gail,et al.  Cause-specific excess deaths associated with underweight, overweight, and obesity. , 2007, JAMA.

[11]  J. Tuomilehto,et al.  Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension: A Prospective Study in Finland , 2004, Hypertension.

[12]  Haskell Wl,et al.  Waist/hip ratio, body mass index and premature cardiovascular disease mortality in US Army veterans during a twenty-three year follow-up study. , 1992 .

[13]  W. Willett,et al.  Test of the National Death Index. , 1984, American journal of epidemiology.

[14]  E. Rimm,et al.  Adiposity and mortality in men. , 2000, American journal of epidemiology.

[15]  A. Folsom,et al.  Body mass index, waist/hip ratio, and coronary heart disease incidence in African Americans and whites. Atherosclerosis Risk in Communities Study Investigators. , 1998, American journal of epidemiology.

[16]  K. Pennert,et al.  Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. , 1984, British medical journal.

[17]  G A Colditz,et al.  Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. , 1992, American journal of epidemiology.

[18]  M. Singer,et al.  Nutritional Epidemiology , 2020, Definitions.

[19]  T. Key,et al.  Validity of self-reported height and weight in 4808 EPIC–Oxford participants , 2002, Public Health Nutrition.

[20]  P. Wahl,et al.  Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. , 1999, Diabetes care.

[21]  J. Manson,et al.  Underweight, overweight, obesity, and excess deaths. , 2005, JAMA.

[22]  T. Lakka,et al.  Abdominal obesity is associated with increased risk of acute coronary events in men. , 2002, European heart journal.

[23]  J. Buring,et al.  Abdominal and total adiposity and risk of coronary heart disease in men , 2001, International Journal of Obesity.

[24]  Walter C Willett,et al.  Obesity as Compared With Physical Activity in Predicting Risk of Coronary Heart Disease in Women , 2006, Circulation.

[25]  J. Twisk,et al.  Superiority of skinfold measurements and waist over waist-to-hip ratio for determination of body fat distribution in a population-based cohort of Caucasian Dutch adults. , 2007, European journal of endocrinology.

[26]  F. Gutzwiller,et al.  Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project , 2004, International Journal of Obesity.

[27]  G A Colditz,et al.  Abdominal adiposity and coronary heart disease in women. , 1998, JAMA.

[28]  C. Morrison,et al.  Waist circumference as a measure for indicating need for weight management , 1995, BMJ.

[29]  Cathy Nonas,et al.  Waist Circumference and Cardiometabolic Risk: A Consensus Statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association , 2007, Obesity.

[30]  G. Watts,et al.  Waist circumference, waist-to-hip ratio and body mass index as predictors of adipose tissue compartments in men. , 2003, QJM : monthly journal of the Association of Physicians.

[31]  P. Björntorp.  Abdominal Fat Distribution and the Metabolic Syndrome , 1992, Journal of cardiovascular pharmacology.

[32]  W. Willett,et al.  Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. , 1986, American journal of epidemiology.

[33]  J. Manson,et al.  Coffee Consumption and Coronary Heart Disease in Men and Women: A Prospective Cohort Study , 2006, Circulation.

[34]  D. Allison,et al.  Waist Circumference and Cardiometabolic Risk , 2007, Diabetes Care.

[35]  R. Jeffery,et al.  Bias in reported body weight as a function of education, occupation, health and weight concern. , 1996, Addictive behaviors.

[36]  W. Willett,et al.  Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. , 1987, The New England journal of medicine.

[37]  E. Topol,et al.  Prevalence of Conventional Risk Factors in Patients With Coronary Heart Disease , 2003 .

[38]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[39]  Lauren Lissner,et al.  Hip circumference and cardiovascular morbidity and mortality in men and women. , 2004, Obesity research.

[40]  A. Folsom,et al.  Body Mass Index, Waist/Hip Ratio, and Coronary Heart Disease Incidence in African Americans and Whites , 1998 .

[41]  D Spiegelman,et al.  Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. , 1995, American journal of epidemiology.

[42]  E. Rimm,et al.  Validity of Self‐Reported Waist and Hip Circumferences in Men and Women , 1990, Epidemiology.

[43]  J. Murabito,et al.  Visceral and Subcutaneous Adipose Tissue Volumes Are Cross-Sectionally Related to Markers of Inflammation and Oxidative Stress: The Framingham Heart Study , 2007, Circulation.

[44]  J. Manson,et al.  A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. , 1991, Archives of internal medicine.

[45]  W. Kannel,et al.  Hazards of obesity--the Framingham experience. , 2009, Acta medica Scandinavica. Supplementum.

[46]  Iain Buchan,et al.  Body Fat Distribution and Risk of Coronary Heart Disease in Men and Women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk Cohort: A Population-Based Prospective Study , 2007, Circulation.

[47]  T. Sellers,et al.  Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. , 2000, Archives of internal medicine.

[48]  J. Sundell.  Obesity and diabetes as risk factors for coronary artery disease: from the epidemiological aspect to the initial vascular mechanisms , 2005, Diabetes, obesity & metabolism.

[49]  P. Björntorp,et al.  Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. , 1984, British medical journal.

[50]  Eric J Topol,et al.  Prevalence of conventional risk factors in patients with coronary heart disease. , 2003, JAMA.

[51]  S. Grundy,et al.  The metabolic syndrome , 2003, The Lancet.

[52]  A. Dyer,et al.  Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. , 1999, JAMA.

[53]  David W. Hosmer,et al.  Applied Survival Analysis: Regression Modeling of Time-to-Event Data , 2008 .

[54]  Thomas N Robinson,et al.  Cardiovascular Health in Childhood: A Statement for Health Professionals From the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association , 2002, Circulation.