Elsevier

Obesity Research & Clinical Practice

Volume 4, Issue 3, July–September 2010, Pages e171-e181
Obesity Research & Clinical Practice

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

https://doi.org/10.1016/j.orcp.2010.01.001Get rights and content

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/m2, those with a BMI > 30.0 kg/m2 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/m2 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.

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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