Copyright © 2002 by the European Society of Cardiology.
Abdominal obesity is associated with increased risk of acute coronary events in men
a Research Institute of Public Health, University of Kuopio, Kuopio, Finland
b Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland
c Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
d Department of Public Health, University of Helsinki, Finland
e Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
f Inner Savo Health Centre, Finland
revised July 13, 2001; accepted July 18, 2001
Abstract
Aims The purpose of the study was to investigate the associations of abdominal obesity and overall obesity with the risk of acute coronary events.
Methods and Results Body mass index indicating overall obesity and waist-to-hip ratio and waist circumference indicating abdominal obesity were measured for 1346 Finnish men aged 42–60 years who had neither cardiovascular disease nor cancer at baseline. There were 123 acute coronary events during an average follow-up of 10·6 years. In Cox regression analyses adjusted for confounding factors, waist-to-hip ratio (P=0·009), waist circumference (P=0·010) and body mass index (P=0·013) as continuous variables were associated directly with the risk of coronary events. These associations were in part explained by blood pressure, diabetes, fasting serum insulin, serum lipids, plasma fibrinogen, and serum uric acid. Waist-to-hip ratio of 
0·91 was associated with a nearly threefold risk of coronary events. Waist-to-hip ratio provided additional information beyond body mass index in predicting coronary heart disease, whereas body mass index did not add to the predictive value of waist-to-hip ratio. Abdominal obesity combined with smoking and poor cardiorespiratory fitness increased the risk of coronary events 5·5 and 5·1 times, respectively.
Conclusions Abdominal obesity is an independent risk factor for coronary heart disease in middle-aged men and even more important than overall obesity. Since the effect of abdominal obesity was strongest in smoking and unfit men, the strategy for lifestyle modification to prevent coronary heart disease should address these issues jointly.
Key Words: Obesity, abdominal obesity, coronary disease, smoking, physical fitness, population studies
f1 Correspondence: Dr Hanna-Maaria Lakka, Department of Public Health and General Practice, University of Kuopio, PO Box 1627, FIN-70211 Kuopio, Finland.
References
- World Health Organization, Obesity: Preventing and managing the global epidemic, Geneva, Switzerland, World Health Organization, 2000
- Seidell JC, Rissanen AM. Time trends in world-wide prevalence of obesity. Bray GA, Bouchard C, James WPT. Handbook of Obesity. New York: Marcel Dekker; 1998. p. 79–91
- Lahti-Koski M, Vartiainen E, Männistö S, Pietinen P. Age, education and occupation as determinants of trends in body mass index in Finland from 1982 to 1997. Int J Obes Relat Metab Disord. 2000;24:1669–1676[CrossRef][ISI][Medline]
- UK National Audit Office, Tackling Obesity in England, http://www.nao.gov.uk/publications/nao_reports/00-01/0001220.pdf
- Reilly JJ, Dorosty AR, Emmett PM. Prevalence of overweight and obesity in British children: cohort study. Br Med J. 1999;319:1039
[Free Full Text] - 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]
- 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]
- Rimm EB, Stampfer MJ, Giovannucci E. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol. 1995;141:1117–1127
[Abstract/Free Full Text] - Rexrode KM, Carey VJ, Hennekens CH. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280:1843–1848
[Abstract/Free Full Text] - Folsom AR, Stevens J, Schreiner PJ, McGovern PG. Body mass index, waist/hip ratio, and coronary heart disease incidence in African Americans and whites. Atherosclerosis Risk in Communities Study Investigators. Am J Epidemiol. 1998;148:1187–1194
[Abstract/Free Full Text] - Folsom AR, Kushi LH, Anderson KE. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med. 2000;160:2117–2128
[Abstract/Free Full Text] - Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Björntorp P, Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J. 1984;288:1401–1404[ISI][Medline]
- Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjöström L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J. 1984;289:1257–1261[ISI][Medline]
- Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738
[Abstract/Free Full Text] - Després J-P, Lemieux I, Prud'homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. Br Med J. 2001;322:716–720
[Free Full Text] - Salonen JT. Is there a continuing need for longitudinal epidemiologic research? The Kuopio Ischaemic Heart Disease Risk Factor Study. Ann Clin Res. 1988;20:46–50[ISI][Medline]
- Rose, GA, Blackburn, H, Gillum, RF, Prineas, RJ, Cardiovascular survey methods, Geneva, Switzerland, World Health Organization, 1982
- Tuomilehto J, Sarti C, Narva EV. The FINMONICA Stroke Register. Community-based stroke registration and analysis of stroke incidence in Finland, 1983–1985. Am J Epidemiol. 1992;135:1259–1270
[Abstract/Free Full Text] - Lakka TA, Venäläinen JM, Rauramaa R, Salonen R, Tuomilehto J, Salonen JT. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. N Engl J Med. 1994;330:1549–1554
[Abstract/Free Full Text] - Salonen JT, Lakka TA, Lakka HM, Valkonen VP, Everson SA, Kaplan GA. Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men. Diabetes. 1998;47:270–275[Abstract]
- Lakka HM, Lakka TA, Tuomilehto J, Sivenius J, Salonen JT. Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Arch Intern Med. 2000;160:1160–1168
[Abstract/Free Full Text] - WHO Monica Project, MONICA Manual, Part IV: Event registration, http://www.ktl.fi/publications/monica/manual/index.htm, 2001
- Tuomilehto J, Arstila M, Kaarsalo E. Acute myocardial infarction (AMI) in Finland—baseline data from the FINMONICA AMI register in 1983–1985. Eur Heart J. 1992;13:577–587
[Abstract/Free Full Text] - Salomaa V, Dobson A, Miettinen H, Rajakangas AM, Kuulasmaa K. Mild myocardial infarction—a classification problem in epidemiologic studies. WHO MONICA Project. J Clin Epidemiol. 1997;50:3–13[CrossRef][ISI][Medline]
- Lakka TA, Lakka HM, Salonen R, Kaplan GA, Salonen JT. Abdominal obesity is associated with accelerated progression of carotid atherosclerosis in men. Atherosclerosis. 2001;154:497–504[CrossRef][ISI][Medline]
- Carey DG. Abdominal obesity. Curr Opin Lipidol. 1998;9:35–40[CrossRef][ISI][Medline]
- Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. Br Med J. 1995;311:1401–1405
[Abstract/Free Full Text] - Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest. 1996;97:2601–2610[ISI][Medline]
- Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet. 1982;1:1165–1168[ISI][Medline]
- Mohamed-Ali V, Pinkney JH, Coppack SW. Adipose tissue as an endocrine and paracrine organ. Int J Obes Relat Metab Disord. 1998;22:1145–1158[CrossRef][ISI][Medline]
- Williams SR, Jones E, Bell W, Davies B, Bourne MW. Body habitus and coronary heart disease in men. A review with reference to methods of body habitus assessment. Eur Heart J. 1997;18:376–393
[Free Full Text] - Molarius A, Seidell JC. Selection of anthropometric indicators for classification of abdominal fatness—a critical review. Int J Obes Relat Metab Disord. 1998;22:719–727[CrossRef][ISI][Medline]
- Marti B, Tuomilehto J, Salomaa V, Kartovaara L, Korhonen HJ, Pietinen P. Body fat distribution in the Finnish population: environmental determinants and predictive power for cardiovascular risk factor levels. J Epidemiol Commun H. 1991;45:131–137[Abstract]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
S. K. Kumanyika, E. Obarzanek, N. Stettler, R. Bell, A. E. Field, S. P. Fortmann, B. A. Franklin, M. W. Gillman, C. E. Lewis, W. C. Poston II, et al. Population-Based Prevention of Obesity: The Need for Comprehensive Promotion of Healthful Eating, Physical Activity, and Energy Balance: A Scientific Statement From American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (Formerly the Expert Panel on Population and Prevention Science) Circulation, July 22, 2008; 118(4): 428 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Subramanian, C. Y. Han, T. Chiba, T. S. McMillen, S. A. Wang, A. Haw III, E. A. Kirk, K. D. O'Brien, and A. Chait Dietary Cholesterol Worsens Adipose Tissue Macrophage Accumulation and Atherosclerosis in Obese LDL Receptor-Deficient Mice Arterioscler. Thromb. Vasc. Biol., April 1, 2008; 28(4): 685 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Ohman, Y. Shen, C. I. Obimba, A. P. Wright, M. Warnock, D. A. Lawrence, and D. T. Eitzman Visceral Adipose Tissue Inflammation Accelerates Atherosclerosis in Apolipoprotein E-Deficient Mice Circulation, February 12, 2008; 117(6): 798 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Poulain, M. Doucet, V. Drapeau, G. Fournier, A. Tremblay, P. Poirier, and F. Maltais Metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease Chronic Respiratory Disease, February 1, 2008; 5(1): 35 - 41. [Abstract] [PDF]
|
|
|
|
 |
|
 A.-L. M. Heath, M. A. Roe, S. L. Oyston, A. R. Gray, S. M. Williams, and S. J. Fairweather-Tait Blood Loss Is a Stronger Predictor of Iron Status in Men Than C282Y Heterozygosity or Diet J. Am. Coll. Nutr., February 1, 2008; 27(1): 158 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kotronen and H. Yki-Jarvinen Fatty Liver: A Novel Component of the Metabolic Syndrome Arterioscler. Thromb. Vasc. Biol., January 1, 2008; 28(1): 27 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Canoy, S. M. Boekholdt, N. Wareham, R. Luben, A. Welch, S. Bingham, I. Buchan, N. Day, and K.-T. Khaw 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 Circulation, December 18, 2007; 116(25): 2933 - 2943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Bogers, W. J. E. Bemelmans, R. T. Hoogenveen, H. C. Boshuizen, M. Woodward, P. Knekt, R. M. van Dam, F. B. Hu, T. L. S. Visscher, A. Menotti, et al. Association of Overweight With Increased Risk of Coronary Heart Disease Partly Independent of Blood Pressure and Cholesterol Levels: A Meta-analysis of 21 Cohort Studies Including More Than 300 000 Persons Arch Intern Med, September 10, 2007; 167(16): 1720 - 1728. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. de Koning, A. T. Merchant, J. Pogue, and S. S. Anand Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies Eur. Heart J., April 2, 2007; (2007) ehm026v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Lapauw, S Goemaere, P Crabbe, J M Kaufman, and J B Ruige Is the effect of testosterone on body composition modulated by the androgen receptor gene CAG repeat polymorphism in elderly men? Eur. J. Endocrinol., March 1, 2007; 156(3): 395 - 401. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Halkjaer, A. Tjonneland, B. L Thomsen, K. Overvad, and T. I. Sorensen Intake of macronutrients as predictors of 5-y changes in waist circumference. Am. J. Clinical Nutrition, October 1, 2006; 84(4): 789 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Haffner Abdominal obesity, insulin resistance, and cardiovascular risk in pre-diabetes and type 2 diabetes Eur. Heart J. Suppl., May 1, 2006; 8(suppl_B): B20 - B25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Snijder, R. van Dam, M Visser, and J. Seidell What aspects of body fat are particularly hazardous and how do we measure them? Int. J. Epidemiol., February 1, 2006; 35(1): 83 - 92. [Full Text] [PDF]
|
|
|
|
 |
|
 G D Kolovou, K K Anagnostopoulou, and D V Cokkinos Pathophysiology of dyslipidaemia in the metabolic syndrome Postgrad. Med. J., June 1, 2005; 81(956): 358 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.P. Empana, P. Ducimetiere, M.A. Charles, and X. Jouven Sagittal Abdominal Diameter and Risk of Sudden Death in Asymptomatic Middle-Aged Men: The Paris Prospective Study I Circulation, November 2, 2004; 110(18): 2781 - 2785. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-H. H. Juo, H.-F. Lin, T. Rundek, E. A. Sabala, B. Boden-Albala, N. Park, M.-Y. Lan, and R. L. Sacco Genetic and Environmental Contributions to Carotid Intima-Media Thickness and Obesity Phenotypes in the Northern Manhattan Family Study Stroke, October 1, 2004; 35(10): 2243 - 2247. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. R. Wessel, C. B. Arant, M. B. Olson, B. D. Johnson, S. E. Reis, B. L. Sharaf, L. J. Shaw, E. Handberg, G. Sopko, S. F. Kelsey, et al. Relationship of Physical Fitness vs Body Mass Index With Coronary Artery Disease and Cardiovascular Events in Women JAMA, September 8, 2004; 292(10): 1179 - 1187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Niskanen, D. E. Laaksonen, K. Nyyssonen, G. Alfthan, H.-M. Lakka, T. A. Lakka, and J. T. Salonen Uric Acid Level as a Risk Factor for Cardiovascular and All-Cause Mortality in Middle-aged Men: A Prospective Cohort Study Arch Intern Med, July 26, 2004; 164(14): 1546 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Strike, K. Magid, L. Brydon, S. Edwards, J. R. McEwan, and A. Steptoe Exaggerated Platelet and Hemodynamic Reactivity to Mental Stress in Men With Coronary Artery Disease Psychosom Med, July 1, 2004; 66(4): 492 - 500. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Koh-Banerjee, N.-F. Chu, D. Spiegelman, B. Rosner, G. Colditz, W. Willett, and E. Rimm Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men Am. J. Clinical Nutrition, October 1, 2003; 78(4): 719 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Newby, D. Muller, J. Hallfrisch, N. Qiao, R. Andres, and K. L Tucker Dietary patterns and changes in body mass index and waist circumference in adults Am. J. Clinical Nutrition, June 1, 2003; 77(6): 1417 - 1425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. O'Brien, M. S. Maurer, H. Taegtmeyer, C. R. Wilson, R. A. Dart, E. R. Jenny-Avital, S. Kenchaiah, D. Levy, R. S. Vasan, and B. M. Massie Obesity and the Risk of Heart Failure N. Engl. J. Med., December 5, 2002; 347(23): 1887 - 1889. [Full Text] [PDF]
|
|
|
|
|
|
H.-M. Lakka, D. E. Laaksonen, T. A. Lakka, L. K. Niskanen, E. Kumpusalo, J. Tuomilehto, and J. T. Salonen The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men JAMA, December 4, 2002; 288(21): 2709 - 2716. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||