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European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2006 27(1):96-106; doi:10.1093/eurheartj/ehi506
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew–Paisley study)

N.F. Murphy1, K. MacIntyre2, S. Stewart3, C.L. Hart2, D. Hole2 and J.J.V. McMurray1,*

1Department of Cardiology, Western Infirmary, Glasgow G12 8QQ, UK
2Public Health and Health Policy, University of Glasgow, Scotland, UK
3Division of Health Sciences, University of South Australia, Adelaide, Australia

Received 11 May 2005; revised 26 August 2005; accepted 2 September 2005; online publish-ahead-of-print 23 September 2005.

* Corresponding author. Tel: +44 141 2111838; fax: +44 141 2112252. E-mail address: j.mcmurray{at}bio.gla.ac.uk

Aims To examine the long-term cardiovascular consequences of obesity and project the cardiovascular consequences of the recent increase in prevalence of obesity.

Methods and results Between 1972 and 1976, 15 402 individuals aged 45–64, living in two towns in the west of Scotland underwent comprehensive cardiovascular screening. We analysed all deaths and hospitalizations for cardiovascular reasons occurring over the subsequent 20 years according to baseline body mass index (BMI) category. Compared with normal weight individuals (BMI 18.5–24.9), obesity (BMI ≥30) was associated with an increased adjusted risk of coronary heart disease (hazard ratio for death or hospital admission: 1.60, 95% CI 1.45–1.78), heart failure (2.09, 1.68–2.59), stroke (1.41, 1.21–1.65), venous thrombo-embolism (2.29, 1.60–3.30), and atrial fibrillation (1.75, 1.17–2.65). Obesity was associated with nine additional cardiovascular deaths and 36 additional cardiovascular hospital admissions for every 100 affected middle-aged men over the subsequent 20 years (seven deaths and 28 admissions in women). Assuming no change in cardiovascular risk profile and outcomes related to obesity, the increase in prevalence in 1998, when compared with 1972, is projected to lead to an additional four cardiovascular deaths and 14 admissions per 100 middle-aged men and women over the next 20 years.

Conclusion Obesity is associated with an increase in a broad range of fatal and non-fatal cardiovascular events. Consideration of only coronary, only fatal, and only first events greatly underestimates the cardiovascular consequences of obesity.

Key Words: Obesity • Coronary heart disease • Heart failure • Atrial fibrillation • Stroke • Thromboembolism


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