Abdominal obesity is associated with increased risk of acute coronary events in men
Obesity is an important risk factor for coronary heart disease (CHD), but the relative importance of overall and abdominal obesity is unclear. Abdominal obesity has been linked to several atherogenic disorders through which it could increase coronary risk. We investigated the associations of overall and abdominal obesity with the risk of acute coronary events and possible biological mechanisms underlying the relationships in a prospective population-based study among 1346 men aged 42-60 years in Finland. Body mass index (BMI) was used as a measure of overall obesity and waist-to-hip ratio (WHR) and waist circumference (WC) were used as measures of abdominal obesity. Data on acute coronary events were obtained by computer linkage to national hospital discharge and death certificate registers. There were 111 acute coronary events during an average follow up of 10 years. Men with the WHR of 0.91-0.94, 0.95-0.98 and >0.98 (three highest quartiles) had a 3.34-fold (95% CI 1.57-7.10, p=0.002), 2.97-fold (1.39-6.34, 0.005) and 3.40-fold (1.61-7.18, 0.001) risk of acute coronary events, respectively, compared with men with the WHR of <0.91 (lowest quartile) adjusting for confounders. Men with the WC of 83.5-89.5 cm, 90.0-95.5 cm and >95.5 cm (three highest quartiles) had a 1.29-fold (0.71-2.37), 1.70-fold (0.96-3.02) and 1.94-fold (1.10-3.40, 0.021) risk of acute coronary events compared with men with the WC of <83.5 cm (lowest quartile). These associations were partly explained by serum HDL cholesterol, triglycerides and apolipoprotein B, systolic and diastolic blood pressure, diabetes, fasting serum insulin, plasma fibrinogen and serum uric acid. BMI had a markedly weaker association with coronary risk than WHR or WC. Men with both overall and abdominal obesity (BMI ≥25.0 kg/m 2 and WHR ≥0.91) had a 4.56-fold risk of acute coronary events compared with men without obesity. This study indicates that even mild abdominal obesity is independently associated with increased risk of CHD, and that the association is partly explained by other coronary risk factors. This study also suggests that abdominal obesity has a stronger association with coronary risk than overall obesity.