Original articleBody mass index, waist circumference, and risk of coronary heart disease: A prospective study among men and women
Introduction
Coronary heart disease remains the leading cause of mortality in the United States [1]. Obesity is a major public health problem in this country, as its prevalence continues to rise [2], [3]. While the relationship between excess weight and the risk of coronary heart disease (CHD) is complex, abdominal obesity is considered to play a fundamental role in the etiology of CHD through adversely affecting several established risk factors [3], [4], [5]. Historically, body mass index (BMI) has been used in epidemiologic studies and by public health organizations to define the degrees of overweight and obesity [6], [7]. For example, a recent report on BMI and mortality from the CDC found increased cardiovascular disease mortality associated with obesity (BMI ≥ 30 kg/m2), though not with overweight (BMI 25–29.9 kg/m2) [8].
However, BMI does not directly assess body fat distribution and is not as good as circumference measures for the measurement of the most metabolically active intra-abdominal fat [9]. Lean muscle mass also can greatly influence BMI, particularly in athletes [9]. The gradual decrease in lean muscle mass with aging also affects the validity and interpretability of BMI as a marker of adiposity among older populations [9]. Waist circumference (WC) is more strongly correlated to intra-peritoneal adipose tissue mass, as measured by computed tomography (CT) or dual energy X-ray absorptiometry (DXA) [10], [11]. Furthermore, WC is easy to measure, is feasible to assess in a clinical setting, and contains relatively little measurement error.
The purpose of the current study was to assess the risk of CHD associated with excess weight measured by BMI and WC in two large prospective cohorts of men and women with 16 years of follow-up, overall and by age, and also to determine the threshold for minimum risk associated with abdominal adiposity.
Section snippets
Study populations
The Health Professionals Follow-up Study (HPFS) is a prospective closed cohort of 51,529 male health professionals ranging in age from 40 to 75 years at enrollment in 1986, with follow-up data through 2004 available for these analyses. In 1986 study participants completed a baseline mailed survey with detailed information about medical history, dietary intake, lifestyle, and demographic information. Every two years subsequently, follow-up questionnaires containing information on interim medical
Results
During the follow-up from 1988 through 2004, a total of 1823 cases of CHD were recorded among the 27,859 eligible men, and 1173 cases of CHD were recorded among the 41,534 eligible women. Table 1 shows the age- and multivariate-adjusted relative risks (RRs) of CHD by BMI category for both the HPFS men and the NHS women. The first multivariate model column shows the RRs associated with CHD for the model without controlling for likely biological mediators, including baseline hypertension,
Discussion
In these new analyses of BMI and waist circumference from two large ongoing prospective cohort studies with over 3000 incident CHD endpoints combined, both BMI and WC strongly predicted future risk of CHD. In addition, both WC and BMI added significantly to models containing the other measure in predicting CHD-risk. WC appeared to predict CHD risk better than did BMI among men and women aged 60 years and older. Furthermore, our results suggest that lower WC cutoffs may be useful in identifying
Funding/support
This work was funded by NIH grants HL35464 and CA55075, and by Sanofi-Aventis.
Disclosures
There are no conflicts of interest to disclose.
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