Published online before print March 24, 2008, doi: 10.1161/CIRCULATIONAHA.107.739714
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(Circulation. 2008;117:1658-1667.)
© 2008 American Heart Association, Inc.
Epidemiology |
Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality
Sixteen Years of Follow-Up in US Women
From the Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Bethesda, Md (C.Z.); Division of Preventive Medicine (K.M.R.) and Channing Laboratory (R.M.v.D., F.B.H.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; and Departments of Nutrition (R.M.v.D., T.Y.L., F.B.H.) and Epidemiology (F.B.H.), Harvard School of Public Health, Boston, Mass.
Reprint requests to Cuilin Zhang, MD, PhD, Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 7B03, MSC 7510, 9000 Rockville Pike, Bethesda, MD 20892–7510. E-mail zhangcu{at}mail.nih.gov or nhbfh@channing.harvard.edu
Received September 11, 2007; accepted January 4, 2008.
Background— Accumulating evidence indicates that abdominal adiposity is positively related to cardiovascular disease (CVD) risk and some other diseases independently of overall adiposity. However, the association of premature death resulting from these diseases with abdominal adiposity has not been widely studied, and findings are inconsistent.
Methods and Results— In a prospective cohort study of 44 636 women in the Nurses’ Health Study, associations of abdominal adiposity with all-cause and cause-specific mortality were examined. During 16 years of follow-up, 3507 deaths were identified, including 751 cardiovascular deaths and 1748 cancer deaths. After adjustment for body mass index and potential confounders, the relative risks across the lowest to the highest waist circumference quintiles were 1.00, 1.11, 1.17, 1.31, and 1.79 (95% confidence interval [CI], 1.47 to 1.98) for all-cause mortality; 1.00, 1.04, 1.04, 1.28, and 1.99 (95% CI, 1.44 to 2.73) for CVD mortality; and 1.00, 1.18, 1.20, 1.34, and 1.63 (95% CI, 1.32 to 2.01) for cancer mortality (all P<0.001 for trend). Among normal-weight women (body mass index, 18.5 to <25 kg/m2), abdominal obesity was significantly associated with elevated CVD mortality: Relative risk associated with waist circumference 
88 cm was 3.02 (95% CI, 1.31 to 6.99) and for waist-to-hip ratio >0.88 was 3.45 (95% CI, 2.02 to 6.92). After adjustment for waist circumference, hip circumference was significantly and inversely associated with CVD mortality.
Conclusions— Anthropometric measures of abdominal adiposity were strongly and positively associated with all-cause, CVD, and cancer mortality independently of body mass index. Elevated waist circumference was associated with significantly increased CVD mortality even among normal-weight women.
CLINICAL PERSPECTIVE
Related Article:
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Clinical Summaries
Circulation 2008 117: 1621.[Extract] [Full Text]
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