Skip Navigation

European Heart Journal 2001 22(1):46-55; doi:10.1053/euhj.2000.2469
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (31)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Ashton, W.D
Right arrow Articles by Wood, D.A
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ashton, W.D
Right arrow Articles by Wood, D.A
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Body mass index and metabolic risk factors for coronary heart disease in women

W.D Ashtona,f1, K Nanchahalb and D.A Woodc

a Cardiac Medicine, Imperial College School of Medicine, London, U.K.
b Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, U.K.
c National Heart & Lung Institute, Imperial College School of Medicine, London, U.K.

Received August 8, 2000; accepted September 18, 2000

Abstract

Aims Prospective epidemiological studies demonstrate an increase in coronary heart disease mortality in women beginning at values of body mass index ≥22 kg.m–2. However, the metabolic basis for this observation has not been adequately studied in women. Our aim was to examine the association between body mass index, metabolic coronary heart disease risk factors and a predicted 10-year coronary heart disease risk score in a large occupational cohort of women in the U.K.

Methods and Results We carried out a cross-sectional survey of cardiovascular risk factors in 14077 women, aged 30–64 years. The main outcome measures were systolic and diastolic blood pressure, serum total cholesterol, HDL cholesterol, total cholesterol/HDL cholesterol ratio, LDL-cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein(a), fasting blood glucose and a predicted 10-year coronary risk score. Across seven categories of body mass index, i.e. <20, 20-, 22-, 24-, 26-, 28- and ≥30kg.m–2, there were highly significant age-adjusted increases in the risk factors (all P<0·001), except for a decrease in HDL cholesterol and ApoA1 (all P<0·001) and no relationship with lipoprotein(a) (P=0·05). Based on a multifactorial 10-year coronary heart disease risk estimate, odds ratios for being in the highest quintile of risk for each category of body mass index, were 1 (<20kg.m–2), 0·91, 1·56, 2·18, 2·97, 3·83 and 4·21 (≥30kg.m–2).

Conclusions The significant rise in metabolic coronary heart disease risk at 22kg.m–2observed in this study is consistent with prospective epidemiological studies in women which have reported an increase in coronary heart disease mortality starting at 22kg.m–2. However, body mass index was a poor discriminator of women at different levels of coronary heart disease risk. The primary goal of weight loss in individuals should be the correction of dysmetabolism, irrespective of the level of body mass index.

Key Words: Body mass index, women, coronary heart disease, metabolic risk

f1 Correspondence: David Ashton, Cardiac Medicine, National Heart & Lung Institute, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, U.K.

References

  1. Ann Intern Med. 1985;103:147–151[Abstract/Free Full Text]
  2. Egger G, Swinburn B. An ‘ecological’ approach to the obesity pandemic. BMJ. 1997;315:477–480[Free Full Text]
  3. Health Survey for England 1998. Health Survey Unit, Erens, R, Primatesta, P, London, HMSO, 1999
  4. Fit for the Future, Department of Health, 1995
  5. Manson JE, Colditz GA, Stampfer MJ. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med. 1990;322:882–889[Abstract]
  6. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968–977[Abstract/Free Full Text]
  7. Jousilahti P, Tuomilehto J, Vartiainen E, Pekkanen J, Puska P. Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle aged men and women in Eastern Finland. Circulation. 1996;93:1372–1379[Abstract/Free Full Text]
  8. Seidell JC, Verschuren WM, van Leer EM, Kromhout D. Overweight, underweight, and mortality. A prospective study of 48,287 men and women. Arch Intern Med. 1996;156:958–963[Abstract/Free Full Text]
  9. Manson JE, Stampfer MJ, Hennekens CH, Willett WC. Body weight and longevity. A reassessment. JAMA. 1987;257:353–358[Abstract/Free Full Text]
  10. Eaker ED, Castelli WP. Coronary heart disease and its risk factors among women in the Framingham study. Eaker E, Packard B, Wenger N. Coronary Heart Disease in Women. New York: Haymarket Doyma; 1987. p. 122–130
  11. Isles CG, Hole DJ, Hawthorne VM, Lever AF. Relation between coronary risk and coronary mortality in women of the Renfrew and Paisley survey: comparison with men. Lancet. 1992;339:702–706[CrossRef][Web of Science][Medline]
  12. Bray GA. Overweight is risking fate. Definition, classification, prevalence and risks. Ann NY Acad Sci. 1987;499:14–28[Web of Science][Medline]
  13. Willet WC, Manson JE, Stampfer MJ. Weight, weight change, and coronary disease in women—risk within the normal weight range. JAMA. 1995;273:461–465[Abstract/Free Full Text]
  14. Manson JE, Willett WC, Stampfer MJ. Body weight and mortality among women. N Engl J Med. 1995;333:677–685[Abstract/Free Full Text]
  15. Davidson MB. Clinical Implications of Insulin Resistance Syndromes. Am J Med. 1995;99:420–426[CrossRef][Web of Science][Medline]
  16. Ashton, WD, Coronary risk factors in women in the UK, University of Salford, 1997
  17. Friedewald WT, Levy RI, Friedrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–509[Abstract]
  18. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile: A statement for health professionals. Circulation. 1991;83:356–362[Free Full Text]
  19. Carstairs V, Morris R. Deprivation and health in Scotland. Aberdeen: Aberdeen University Press; 1990.
  20. Heart. 1998;80:S1–S29[Free Full Text]
  21. Wood DA, De Backer G, Faergeman O, Graham I, Mancia G, Pyörölä K. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Eur Heart J. 1998;19:1434–1503[Free Full Text]
  22. Ramsay LE, Williams B, Johnston DG. British Hypertension Society guidelines for hypertension management 1999: summary. BMJ. 1999;319:630–635[Free Full Text]
  23. Kannel WB. Role of blood pressure in cardiovascular morbidity and mortality. Prog Cardiovasc Dis. 1974;17:5–24[CrossRef][Web of Science][Medline]
  24. Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH. Weight and blood pressure. JAMA. 1978;240:1607–1610[Abstract/Free Full Text]
  25. Dyer AR, Elliott P. The Intersalt Study: relations of body mass index to blood pressure. J Hum Hypertens. 1989;3:299–308[Web of Science][Medline]
  26. Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med. 1993;119:655–660[Abstract/Free Full Text]
  27. Higgins M, Kannel W, Garrison R, Pinsky J, Stokes J. Hazards of obesity—the Framingham experience. Acta Med Scand Suppl. 1988;723:23–36[Medline]
  28. Brunner EJ, Marmot MG, White IR. Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II study. Atherosclerosis. 1993;102:195–207[CrossRef][Web of Science][Medline]
  29. Sundell BI, Nilsson TK, Hallmans G, Hellsten G, Dahlen G. Interrelationships between plasma levels of plasminogen activator inhibitor, tissue plasminogen activator, lipoprotein (a) and established cardiovascular risk factors in a North Swedish population. Atherosclerosis. 1989;80:9–16[CrossRef][Web of Science][Medline]
  30. Jenner JL, Ordovas JM, Lamon-Fava S. Effects of age, sex and menopausal status on plasma lipoprotein (a) levels. The Framingham Offspring Study. Circulation. 1993;87:1135–1141[Abstract/Free Full Text]
  31. Bostom AG, Gagnon DR, Cupples A. A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women: the Framingham Heart Study. Circulation. 1994;90:1688–1695[Abstract/Free Full Text]
  32. Nguyen TT, Ellefson RD, Hodge DO, Bailey KR, Kottke TE, Abu-Lebdeh HS. Predictive Value of Electrophoretically Detected Lipoprotein (a) for Coronary Heart Disease in a Community-Based Cohort of 9936 Men and Women. Circulation. 1997;96:1390–1397[Abstract/Free Full Text]
  33. Garrison RJ. Healthy adiposity in women: the Framingham Offspring Study. J Am Coll Nutr. 1993;12:357–362[Abstract]
  34. Tokunaga K, Matsuzawa Y, Kotani K. Ideal body weight estimated from the body mass index with the lowest morbidity. Int J Obes. 1991;15:1–5[Medline]
  35. Shaper AG, Wannamethee SG, Walker M. Body weight: implications for the prevention of coronary heart disease, stroke, and diabetes in a cohort study of middle aged men. BMJ. 1997;314:1311–1317[Abstract/Free Full Text]
  36. Bouchard C, Bray GA, Hubbard VS. Basic and clinical aspects of regional fat distribution. Am J Clin Nutr. 1990;52:946–950[Free Full Text]
  37. Despres JP. The insulin resistance-dyslipidaemic syndrome of visceral obesity: effect on patients risk. Obes Res. 1998;Suppl 1:8S–17S
  38. Lapidus L, Bengtsson C, Larsson, Pennert K, Rybo E, Sjostrom L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow-up of participants in the population study of the women of Gothenburg, Sweden. BMJ. 1984;289:1257–1261[Abstract/Free Full Text]
  39. Bjorntorp P. Regional patterns of fat distribution. Ann Intern Med. 1985;103:994–995[Web of Science][Medline]
  40. Wellens RI, Roche AF, Khamis HJ, Jackson AS, Pollock ML, Siervogel RM. Relationships between the body mass index and body composition. Obes Res. 1996;4:35–44[Web of Science][Medline]
  41. Joint Health Surveys Unit, Health Survey for England 1996, Prescott-Clarke, PPrimatesta, P, London, The Stationary Office, 1998
  42. Baumgartner RN, Heymsfield SB, Roche AF. Human body composition and the epidemiology of chronic disease. Obes Res. 1995;3:73–95[Web of Science][Medline]
  43. Stampfer MJ, Maclure KM, Colditz GA, Manson JE, Willet WC. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr. 1992;55:652–658[Abstract/Free Full Text]
  44. Giovannuci E, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity and risk of colorectal adenoma in women. United States Cancer Causes Control. 1996;7:235–253
  45. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnoea in women. Chest. 1995;107:362–366[Abstract/Free Full Text]
  46. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report. National Institutes of Health, National Heart, Lung, and Blood Institute, 1998
  47. Meisler JG, St Jeor S. Summary and recommendations from the American Health Foundation's Expert Panel on Healthy Weight. Am J Clin Nutr. 1996;63:474S–477S[Free Full Text]
  48. Han TS, Richmond P, Avenell A, Lean MEJ. Waist circumference reduction and cardiovascular benefits during weight loss in women. Int J Obes. 1997;21:127–134[CrossRef][Web of Science][Medline]
  49. Andersen RE, Wadden TA, Bartlett SJ, Vogt RA, Weinstock RS. Relation of weight loss to changes in serum lipids and lipoproteins in obese women. Am J Clin Nutr. 1995;62:350–357[Abstract/Free Full Text]
  50. Wooley SC, Garner DM. Obesity treatment: the high cost of false hope. J Am Diet Assoc. 1991;91:1248–1251[Web of Science][Medline]
  51. Kannel WB, D'Agostino RB, Cobb JL. Effect of weight on cardiovascular disease. Am J Clin Nut. 1996;63:419–422S
  52. Jung RT. Obesity as a disease. Br Med Bull. 1997;53:307–321[Abstract/Free Full Text]
  53. Mann JI, Lewis B, Shepherd J. Blood lipid concentrations and other cardiovascular risk factors: distribution, prevalence and detection in Britain. BMJ. 1988;296:1702–1706[Abstract/Free Full Text]
  54. Smith WCS, Tunstall-Pedoe H, Crombie IK, Tavendale R. Concomitants of excess coronary deaths—major risk factor and lifestyle findings from 10,359 men and women in the Scottish Heart Health Study. Scot Med J. 1989;34:550–555
  55. Larsson B, Bengtsson C, Bjorntorp P. Is abdominal fat distribution a major explanation for the sex difference in the incidence of myocardial infarction? Am J Epidemiol. 1992;135:266–273[Abstract/Free Full Text]
  56. Lemieux S, Prud'homme D, Bouchard C, Tremblay A, Despres J. A single threshold value of waist girth identifies normal weight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr. 1996;64:685–693[Abstract/Free Full Text]
  57. McMichael, AJ, Standardized mortality ratios and the ‘healthy worker effect’: scratching beneath the surface, J Occup Med, 1976, 18, 165, 8
  58. Jones A, Cronin PA, Bowen M. Comparison of risk factors for coronary heart disease among attenders and non-attenders at a screening programme. Br J Gen Pract. 1993;43:375–377[Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 JNCI J Natl Cancer InstHome page
R. Ballard-Barbash, S. Hunsberger, M. H. Alciati, S. N. Blair, P. J. Goodwin, A. McTiernan, R. Wing, and A. Schatzkin
Physical Activity, Weight Control, and Breast Cancer Risk and Survival: Clinical Trial Rationale and Design Considerations
J Natl Cancer Inst, May 6, 2009; 101(9): 630 - 643.
[Abstract] [Full Text] [PDF]

Home page
 AMERICAN JOURNAL OF LIFESTYLE MEDICINEHome page
S. S. Bassuk and J. E. Manson
Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence
American Journal of Lifestyle Medicine, June 1, 2008; 2(3): 191 - 213.
[Abstract] [PDF]

Home page
 Int J EpidemiolHome page
N. Rigby
Commentary: Counterpoint to Campos et al.
Int. J. Epidemiol., February 1, 2006; 35(1): 79 - 80.
[Full Text] [PDF]

Home page
 Diabetes CareHome page
N. Scopinaro, G. M. Marinari, G. B. Camerini, F. S. Papadia, and G. F. Adami
Specific Effects of Biliopancreatic Diversion on the Major Components of Metabolic Syndrome: A long-term follow-up study
Diabetes Care, October 1, 2005; 28(10): 2406 - 2411.
[Abstract] [Full Text] [PDF]

Home page
 HypertensionHome page
F. Thomas, K. Bean, B. Pannier, J.-M. Oppert, L. Guize, and A. Benetos
Cardiovascular Mortality in Overweight Subjects: The Key Role of Associated Risk Factors
Hypertension, October 1, 2005; 46(4): 654 - 659.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. E. Manson, P. J. Skerrett, P. Greenland, and T. B. VanItallie
The Escalating Pandemics of Obesity and Sedentary Lifestyle: A Call to Action for Clinicians
Arch Intern Med, February 9, 2004; 164(3): 249 - 258.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
W. Klein
Cardiovascular disease at the turn of the millennium: focus on Europe
Eur. Heart J. Suppl., October 1, 2001; 3(suppl_M): M2 - M6.
[Abstract] [PDF]

Home page
 BMJHome page
G. Williams
Diabetes black spots and death by postcode
BMJ, June 9, 2001; 322(7299): 1375 - 1376.
[Full Text] [PDF]

Home page
 BMJHome page
S. Liu and J. E Manson
What is the optimal weight for cardiovascular health?
BMJ, March 17, 2001; 322(7287): 631 - 632.
[Full Text]

Home page
 Eur Heart JHome page
J.S. Alpert, R.S. Flinn, and I.P. Flinn
So what's wrong with being fat?
Eur. Heart J., January 1, 2001; 22(1): 10 - 11.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (31)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Ashton, W.D
Right arrow Articles by Wood, D.A
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ashton, W.D
Right arrow Articles by Wood, D.A
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?