American Journal of Epidemiology Vol. 141, No. 12: 1117-1127
Copyright © 1995 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Body Size and Fat Distribution as Predictors of Coronary Heart Disease among Middle-aged and Older US Men
1Department of Epidemiology, Harvard School of Public Health Boston, MA
2Department of Nutrition, Harvard School of Public Hearth Boston, MA
3Department of Biostatistics, Harvard School of Public Health Boston, MA
4Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital Boston, MA
Reprint requests to Dr. Eric Rimm, Department of Nutrition, Harvard School of Public Health, 665 Huntingdon Avenue, Boston, MA 02115.
Obesity, android fat distribution, and other anthropometric measures have been associated with coronary heart disease in long-term prospective studies. However, fluctuations in weight due to age-related hormonal changes and changes in lifestyle practices may bias relative risk estimates over a long follow-up period. The authors prospectively studied the association between body mass index (BMI) (kg/m2), waist-to-hip ratio, and height as independent predictors of incident coronary heart disease in a 3-year prospective study among 29,122 US men aged 40–75 years in 1986. The authors documented 420 incident coronary events during the follow-up period. Body mass index, waist-to-hip ratio, short stature, and weight gain since age 21 were associated with an increased risk of coronary heart disease. Among men younger than 65, after adjusting for other coronary risk factors, the relative risk was 1.72 (95% confidence interval (Cl) 1.10–2.69) for men with BMI of 25–28.9,2.61 (95% Cl 1.54–4.42) for BMI of 29.0–32.9, and 3.44 (95% Cl 1.67–7.09) for obese men with BMI 
33 compared with lean men with BMI <23.0. Among men 65 years of age, the association between BMI and risk of coronary heart disease was much weaker. However, in this age group, the waist-to-hip ratio was a much stronger predictor of risk (relative risk = 2.76, 95% Cl 1.22–6.23 between extreme quintiles). These results suggest that for younger men, obesity, independent of fat distribution, is a strong risk factor for coronary heart disease. For older men, measures of fat distribution may be better than body mass index at predicting risk of coronary disease.
adipose tissue; aging; body mass index; coronary disease; obesity
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M. Lundberg, F. Diderichsen, and J. Hallqvist Is the association between short stature and myocardial infarction explained by childhood exposures-a population-based case referent study (SHEEP) Scand J Public Health, October 1, 2002; 30(4): 249 - 258. [Abstract] [PDF]
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E. Cho, J. E. Manson, M. J. Stampfer, C. G. Solomon, G. A. Colditz, F. E. Speizer, W. C. Willett, and F. B. Hu A Prospective Study of Obesity and Risk of Coronary Heart Disease Among Diabetic Women Diabetes Care, July 1, 2002; 25(7): 1142 - 1148. [Abstract] [Full Text] [PDF]
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S. M. Grundy Obesity, Metabolic Syndrome, and Coronary Atherosclerosis Circulation, June 11, 2002; 105(23): 2696 - 2698. [Full Text] [PDF]
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J.-M. Oppert, M.-A. Charles, N. Thibult, B. Guy-Grand, E. Eschwege, and P. Ducimetiere Anthropometric estimates of muscle and fat mass in relation to cardiac and cancer mortality in men: the Paris Prospective Study Am. J. Clinical Nutrition, June 1, 2002; 75(6): 1107 - 1113. [Abstract] [Full Text] [PDF]
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S. Sans Watch the belly to protect the heart Eur. Heart J., May 1, 2002; 23(9): 687 - 689. [Full Text] [PDF]
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H.-M. Lakka, T.A. Lakka, J. Tuomilehto, and J.T. Salonen Abdominal obesity is associated with increased risk of acute coronary events in men Eur. Heart J., May 1, 2002; 23(9): 706 - 713. [Abstract] [Full Text] [PDF]
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P. Schnohr, J.S. Jensen, H. Scharling, and B.G. Nordestgaard Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12000 men and women from The Copenhagen City Heart Study Eur. Heart J., April 2, 2002; 23(8): 620 - 626. [Abstract] [Full Text] [PDF]
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D. J McNamara Eggs and heart disease risk: perpetuating the misperception Am. J. Clinical Nutrition, February 1, 2002; 75(2): 333 - 334. [Full Text] [PDF]
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S. A. Schreyer, C. Vick, T. C. Lystig, P. Mystkowski, and R. C. LeBoeuf LDL receptor but not apolipoprotein E deficiency increases diet-induced obesity and diabetes in mice Am J Physiol Endocrinol Metab, January 1, 2002; 282(1): E207 - E214. [Abstract] [Full Text] [PDF]
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A. E. Field, E. H. Coakley, A. Must, J. L. Spadano, N. Laird, W. H. Dietz, E. Rimm, and G. A. Colditz Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period Arch Intern Med, July 9, 2001; 161(13): 1581 - 1586. [Abstract] [Full Text] [PDF]
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A. Heiat, V. Vaccarino, and H. M. Krumholz An Evidence-Based Assessment of Federal Guidelines for Overweight and Obesity as They Apply to Elderly Persons Arch Intern Med, May 14, 2001; 161(9): 1194 - 1203. [Abstract] [Full Text] [PDF]
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J. Al Suwaidi, S. T. Higano, D. R. Holmes Jr., R. Lennon, and A. Lerman Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1523 - 1528. [Abstract] [Full Text] [PDF]
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M. Brochu, A. Tchernof, I. J. Dionne, C. K. Sites, G. H. Eltabbakh, E. A. H. Sims, and E. T. Poehlman What Are the Physical Characteristics Associated with a Normal Metabolic Profile Despite a High Level of Obesity in Postmenopausal Women? J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 1020 - 1025. [Abstract] [Full Text]
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 M. Visser, L. M. Bouter, G. M. McQuillan, M. H. Wener, and T. B. Harris Low-Grade Systemic Inflammation in Overweight Children Pediatrics, January 1, 2001; 107(1): 13e - 13. [Abstract] [Full Text]
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A. R. Dyer, J. Stamler, and P. Greenland Associations of Weight Change and Weight Variability with Cardiovascular and All-Cause Mortality in the Chicago Western Electric Company Study Am. J. Epidemiol., August 15, 2000; 152(4): 324 - 333. [Abstract] [Full Text] [PDF]
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I. Baik, A. Ascherio, E. B. Rimm, E. Giovannucci, D. Spiegelman, M. J. Stampfer, and W. C. Willett Adiposity and Mortality in Men Am. J. Epidemiol., August 1, 2000; 152(3): 264 - 271. [Abstract] [Full Text] [PDF]
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A. R. Folsom, L. H. Kushi, K. E. Anderson, P. J. Mink, J. E. Olson, C.-P. Hong, T. A. Sellers, D. Lazovich, and R. J. Prineas Associations of General and Abdominal Obesity With Multiple Health Outcomes in Older Women: The Iowa Women's Health Study Arch Intern Med, July 24, 2000; 160(14): 2117 - 2128. [Abstract] [Full Text] [PDF]
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M. Kiernan and M. A. Winkleby Identifying Patients for Weight-Loss Treatment: An Empirical Evaluation of the NHLBI Obesity Education Initiative Expert Panel Treatment Recommendations Arch Intern Med, July 24, 2000; 160(14): 2169 - 2176. [Abstract] [Full Text] [PDF]
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National Task Force on the Prevention and Treatmen Overweight, Obesity, and Health Risk Arch Intern Med, April 10, 2000; 160(7): 898 - 904. [Abstract] [Full Text] [PDF]
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C. M. Apovian Invited Review: The Medical Management of Obesity and the Role of Pharmacotherapy: An Update Nutr Clin Pract, February 1, 2000; 15(1): 5 - 12. [Abstract] [PDF]
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M. Visser, L. M. Bouter, G. M. McQuillan, M. H. Wener, and T. B. Harris Elevated C-Reactive Protein Levels in Overweight and Obese Adults JAMA, December 8, 1999; 282(22): 2131 - 2135. [Abstract] [Full Text] [PDF]
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F. Gueyffier, J.-P. Boissel, S. Pocock, F. Boutitie, J. Coope, J. Cutler, T. Ekbom, R. Fagard, L. Friedman, K. Kerlikowske, et al. Identification of Risk Factors in Hypertensive Patients : Contribution of Randomized Controlled Trials Through an Individual Patient Database Circulation, November 2, 1999; 100 (18): e88 - e94. [Abstract] [Full Text] [PDF]
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