American Journal of Epidemiology Advance Access originally published online on October 13, 2006
American Journal of Epidemiology 2006 164(12):1150-1159; doi:10.1093/aje/kwj341
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ORIGINAL CONTRIBUTIONS |
Value of the Sagittal Abdominal Diameter in Coronary Heart Disease Risk Assessment: Cohort Study in a Large, Multiethnic Population
1 Division of Research, Kaiser Permanente of Northern California, Oakland, CA
2 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
3 Endocrinology and Metabolism Section, San Francisco General Hospital, San Francisco, CA
4 Department of Medicine, University of California, San Francisco, San Francisco, CA
Correspondence to Dr. Carlos Iribarren, Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, Oakland, CA 94612 (e-mail: cgi{at}dor.kaiser.org).
Whether visceral obesity predicts coronary heart disease (CHD) risk above and beyond overall fatness remains unsettled. Moreover, whether the association between visceral obesity and CHD risk differs by sex, age, race, and overall fatness is poorly understood. The authors conducted a cohort study among 101,765 adult members of Kaiser Permanente of Northern California who underwent multiphasic health checkups between 1965 and 1970. After a median of 12 years and adjustment for age, race, body mass index (BMI), educational level, smoking, alcohol consumption, and hormone replacement therapy (in women), the upper quartile of standing sagittal abdominal diameter, relative to the lowest quartile, was associated with a 1.42-fold increased hazard of CHD in men (95% confidence interval: 1.30, 1.55) and a 1.44-fold increased hazard of CHD in women (95% confidence interval: 1.30, 1.59). Further adjustment for metabolic mediators attenuated the association minimally. Standing sagittal abdominal diameter was a consistent predictor of CHD across racial groups but was more strongly associated with CHD in the younger age group. Joint consideration of BMI/standing sagittal abdominal diameter categories better discriminated risk of CHD compared with use of BMI alone. In conclusion, standing sagittal abdominal diameter was a strong predictor of CHD independently of BMI and added incremental CHD risk prediction at each level of BMI.
abdominal fat; body mass index; cohort studies; coronary disease; obesity
Abbreviations: BMI, body mass index; CHD, coronary heart disease; SAD, sagittal abdominal diameter