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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