Obesity is associated with fatal coronary heart disease independently of traditional risk factors and deprivation
- 14 February 2011
- Vol. 97 (7), 564-568
- https://doi.org/10.1136/hrt.2010.211201
Abstract
Background The effect of body mass index (BMI) on coronary heart disease (CHD) risk is attenuated when mediators of this risk (such as diabetes, hypertension and hyperlipidaemia) are accounted for. However, there is now evidence of a differential effect of risk factors on fatal and non-fatal CHD events, with markers of inflammation more strongly associated with fatal than non-fatal events. Objective To describe the association with BMI separately for both fatal and non-fatal CHD risk after accounting for classical risk factors and to assess any independent effects of obesity on CHD risk. Methods and results In the West of Scotland Coronary Prevention Study BMI in 6082 men (mean age 55 years) with hypercholesterolaemia, but no history of diabetes or CVD, was related to the risk of fatal and non-fatal CHD events. After excluding participants with any event in the first 2 years, 1027 non-fatal and 214 fatal CHD events occurred during 14.7 years of follow-up. A minimally adjusted model (age, sex, statin treatment) and a maximally adjusted model (including known CVD risk factors and deprivation) were compared, with BMI 25–27.4 kg/m2 as referent. The risk of non-fatal events was similar across all BMI categories in both models. The risk of fatal CHD events was increased in men with BMI 30.0–39.9 kg/m2 in both the minimally adjusted model (HR=1.75 (95% CI 1.12 to 2.74)) and the maximally adjusted model (HR=1.60 (95% CI 1.02 to 2.53)). Conclusions These hypothesis generating data suggest that obesity is associated with fatal, but not non-fatal, CHD after accounting for known cardiovascular risk factors and deprivation. Clinical trial registration WOSCOPS was carried out and completed before the requirement for clinical trial registration.Keywords
This publication has 28 references indexed in Scilit:
- Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up†European Heart Journal, 2010
- Comparison of the associations of body mass index and measures of central adiposity and fat mass with coronary heart disease, diabetes, and all-cause mortality: a study using data from 4 UK cohortsThe American Journal of Clinical Nutrition, 2010
- Unraveling the Directional Link between Adiposity and Inflammation: A Bidirectional Mendelian Randomization ApproachJournal of Clinical Endocrinology & Metabolism, 2010
- C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysisThe Lancet, 2009
- Major Lipids, Apolipoproteins, and Risk of Vascular DiseaseJAMA, 2009
- Are Markers of Inflammation More Strongly Associated with Risk for Fatal Than for Nonfatal Vascular Events?PLoS Medicine, 2009
- Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studiesThe Lancet, 2009
- Nutrient sensing and inflammation in metabolic diseasesNature Reviews Immunology, 2008
- Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew–Paisley study)European Heart Journal, 2005
- A Prospective Study of Obesity and Risk of Coronary Heart Disease in WomenNew England Journal of Medicine, 1990