This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 116/25/2933    most recent CIRCULATIONAHA.106.673756v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions patientINFORMation Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Canoy, D. Articles by Khaw, K.-T. Search for Related Content PubMed PubMed Citation Articles by Canoy, D. Articles by Khaw, K.-T. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Obesity Related Collections Acute myocardial infarction Chronic ischemic heart disease Epidemiology

(Circulation. 2007;116:2933-2943.)
© 2007 American Heart Association, Inc.

Epidemiology

Body Fat Distribution and Risk of Coronary Heart Disease in Men and Women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk Cohort

A Population-Based Prospective Study

Dexter Canoy, MPhil, MD, PhD; S. Matthijs Boekholdt, MD, PhD; Nicholas Wareham, MBBS, FRCP; Robert Luben, BSc; Ailsa Welch, PhD; Sheila Bingham, PhD; Iain Buchan, MD, FFPH; Nicholas Day, PhD, FRS; Kay-Tee Khaw, MBBChir, FRCP

From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (D.C., A.W., R.L., S.B., N.D., K.K.); Northwest Institute for Bio-Health Informatics, University of Manchester, Manchester, UK (D.C., I.B.); Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands (S.M.B.); MRC Epidemiology Unit, Cambridge, UK (N.W.); MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Cambridge, UK (S.B.); and MRC Dunn Human Nutrition Unit, Cambridge, UK (S.B.).

Correspondence to Dexter Canoy, MPhil, MD, PhD, Northwest Institute for Bio-Health Informatics, The University of Manchester, University Place (1st Floor), Oxford Rd, Manchester M13 9PL, UK. E-mail dexter.canoy{at}manchester.ac.uk

Received November 1, 2006; accepted October 16, 2007.

Background— Body fat distribution has been cross-sectionally associated with atherosclerotic disease risk factors, but the prospective relation with coronary heart disease remains uncertain.

Methods and Results— We examined the prospective relation between fat distribution indices and coronary heart disease among 24 508 men and women 45 to 79 years of age using proportional hazards regression. During a mean 9.1 years of follow-up, 1708 men and 892 women developed coronary heart disease. The risk for developing subsequent coronary heart disease increased continuously across the range of waist-hip ratio. Hazard ratios (95% CI) of the top versus bottom fifth of waist-hip ratio were 1.55 (1.28 to 1.73) in men and 1.91 (1.44 to 2.54) in women after adjustment for body mass index and other coronary heart disease risk factors. Hazard ratios increased with waist circumference, but risk estimates for waist circumference without hip circumference adjustment were lower by 10% to 18%. After adjustment for waist circumference, body mass index, and coronary heart disease risk factors, hazard ratios for 1-SD increase in hip circumference were 0.80 (95% CI, 0.74 to 0.87) in men and 0.80 (95% CI, 0.69 to 0.93) in women. Hazard ratios for body mass index were greatly attenuated when we adjusted for waist-hip ratio or waist circumference and other covariates.

Conclusions— Indices of abdominal obesity were more consistently and strongly predictive of coronary heart disease than body mass index. These simple and inexpensive measurements could be used to assess obesity-related coronary heart disease risk in relatively healthy men and women.

---

 

CLINICAL PERSPECTIVE

Find additional patient-related information at:

http://www.americanheart.org/presenter.jhtml?identifier=3053527

This article has been cited by other articles:

				M. T. Severinsen, S. R. Kristensen, S. P. Johnsen, C. Dethlefsen, A. Tjonneland, and K. Overvad Anthropometry, Body Fat, and Venous Thromboembolism: A Danish Follow-Up Study Circulation, November 10, 2009; 120(19): 1850 - 1857. [Abstract] [Full Text] [PDF]

				R. S Bhopal and S. B Rafnsson Could mitochondrial efficiency explain the susceptibility to adiposity, metabolic syndrome, diabetes and cardiovascular diseases in South Asian populations? Int. J. Epidemiol., August 1, 2009; 38(4): 1072 - 1081. [Abstract] [Full Text] [PDF]

				M. Postorino, C. Marino, G. Tripepi, C. Zoccali, and on behalf of the CREDIT (Calabria Registry of Dial Abdominal Obesity and All-Cause and Cardiovascular Mortality in End-Stage Renal Disease J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1265 - 1272. [Abstract] [Full Text] [PDF]

				K.-H. Mak, D. L. Bhatt, M. Shao, S. M. Haffner, C. W. Hamm, G. J. Hankey, S. C. Johnston, G. Montalescot, P. G. Steg, S. R. Steinhubl, et al. The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease Eur. Heart J., April 1, 2009; 30(7): 857 - 865. [Abstract] [Full Text] [PDF]

				F. Andreotti, T. Rio, and A. Lavorgna Body fat and cardiovascular risk: understanding the obesity paradox Eur. Heart J., April 1, 2009; 30(7): 752 - 754. [Full Text] [PDF]

				K. M Flegal and B. I Graubard Estimates of excess deaths associated with body mass index and other anthropometric variables Am. J. Clinical Nutrition, April 1, 2009; 89(4): 1213 - 1219. [Abstract] [Full Text] [PDF]

				J. S. Rana, B. J. Arsenault, J.-P. Despres, M. Cote, P. J. Talmud, E. Ninio, J. W. Jukema, N. J. Wareham, J. J.P. Kastelein, K.-T. Khaw, et al. Inflammatory biomarkers, physical activity, waist circumference, and risk of future coronary heart disease in healthy men and women Eur. Heart J., February 18, 2009; (2009) ehp010v1. [Abstract] [Full Text] [PDF]

				S. E. Litwin Which Measures of Obesity Best Predict Cardiovascular Risk? J. Am. Coll. Cardiol., August 19, 2008; 52(8): 616 - 619. [Full Text] [PDF]

				S. Sam, S. Haffner, M. H. Davidson, R. B. D'Agostino Sr., S. Feinstein, G. Kondos, A. Perez, and T. Mazzone Relationship of Abdominal Visceral and Subcutaneous Adipose Tissue With Lipoprotein Particle Number and Size in Type 2 Diabetes Diabetes, August 1, 2008; 57(8): 2022 - 2027. [Abstract] [Full Text] [PDF]

				M. Zeller, P. G. Steg, J. Ravisy, L. Lorgis, Y. Laurent, P. Sicard, L. Janin-Manificat, J.-C. Beer, H. Makki, A.-C. Lagrost, et al. Relation Between Body Mass Index, Waist Circumference, and Death After Acute Myocardial Infarction Circulation, July 29, 2008; 118(5): 482 - 490. [Abstract] [Full Text] [PDF]

				J. H. Ix, M. A. Allison, J. O. Denenberg, M. Cushman, and M. H. Criqui Novel cardiovascular risk factors do not completely explain the higher prevalence of peripheral arterial disease among African Americans. The San Diego Population Study. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2347 - 2354. [Abstract] [Full Text] [PDF]

				P. Poirier Healthy Lifestyle: Even If You Are Doing Everything Right, Extra Weight Carries an Excess Risk of Acute Coronary Events Circulation, June 17, 2008; 117(24): 3057 - 3059. [Full Text] [PDF]

				J.-P. Despres, I. Lemieux, J. Bergeron, P. Pibarot, P. Mathieu, E. Larose, J. Rodes-Cabau, O. F. Bertrand, and P. Poirier Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk Arterioscler Thromb Vasc Biol, June 1, 2008; 28(6): 1039 - 1049. [Abstract] [Full Text] [PDF]