Published online before print October 18, 2004, doi: 10.1161/01.CIR.0000146395.64065.BA
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(Circulation. 2004;110:2781-2785.)
© 2004 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Sagittal Abdominal Diameter and Risk of Sudden Death in Asymptomatic Middle-Aged Men
The Paris Prospective Study I
From INSERM Avenir (J.P.E., X.J.), Epidemiology of Sudden Death in the Population, and INSERM U258 (J.P.E., P.D., M.A.C., X.J.), Cardiovascular and Metabolic Epidemiology Unit, Villejuif, France.
Correspondence to Dr J.P. Empana, INSERM Avenir-U258, Hopital Paul Brousse, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif, France. E-mail empana{at}vjf.inserm.fr
Received December 30, 2003; de novo received April 22, 2004; accepted June 30, 2004.
Background— Abdominal (visceral) and overall obesity are both related to coronary heart disease mortality risk; however, the relative contribution of these 2 components of fat deposit in the etiology of sudden death is unknown.
Methods and Results— We used the data from 7079 asymptomatic men of the Paris Prospective Study I who were free of ischemic heart disease and who were 43 to 52 years of age at first clinical examination between 1967 and 1972. Body mass index (BMI) and sagittal abdominal diameter (SAD) were measured at baseline and used as markers of overall and abdominal obesity. During a follow-up of 23 years, there were 118 sudden deaths and 192 fatal myocardial infarctions. After adjustment for baseline level of cardiovascular risk factors, trunk subcutaneous fat, and thoracic diameter, the ratio of the fifth over the first quintile of SAD was 2.6 (95% CI 1.0 to 6.7) and 2. 6 (95% CI 1.3 to 5.1) for sudden death and fatal myocardial infarction, respectively, and the risk of sudden death increased proportionally with SAD level. The corresponding ratios for BMI were 2.0 (95% CI 1.1 to 3.8) and 1.0 (95% CI 0.6 to 1.7), respectively. Compared with men with low SAD (first tertile) and normal BMI (<25 kg/m2), men with elevated SAD (third tertile) were at increased risk of sudden death but not of fatal myocardial infarction, whether they were of normal weight (multivariate adjusted relative risk 3. 0 [95% CI 1.3 to 6. 9]) or overweight (BMI 
25 kg/m2; 1.9 [95% CI 1.0 to 3.9]).
Conclusions— In asymptomatic French middle-aged men, larger SAD was associated with a particularly increased risk of sudden death, independent of BMI level and known cardiovascular risk factors.
Key Words: epidemiology • risk factors • death, sudden • obesity
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