Obesity (BMI ≥33) was strongly associated with incident coronary heart disease in men <65 years (RR 3.44; 95% CI 1.67-7.09), whereas waist-to-hip ratio was a stronger predictor in men ≥65 years.
Cohort (n=29,122)
Do body mass index and waist-to-hip ratio predict incident coronary heart disease in middle-aged and older men?
Obesity is a strong independent risk factor for coronary heart disease in younger men, while fat distribution (waist-to-hip ratio) is a better predictor in older men.
Effect estimate: RR 3.44 (95% CI 1.67-7.09)
Obesity, android fat distribution, and other anthropometric measures have been associated with coronary heart disease in long-term prospective studies. However, fluctuations in weight due to age-related hormonal changes and changes in lifestyle practices may bias relative risk estimates over a long follow-up period. The authors prospectively studied the association between body mass index (BMI) (kg/m2), waist-to-hip ratio, and height as independent predictors of incident coronary heart disease in a 3-year prospective study among 29,122 US men aged 40-75 years in 1986. The authors documented 420 incident coronary events during the follow-up period. Body mass index, waist-to-hip ratio, short stature, and weight gain since age 21 were associated with an increased risk of coronary heart disease. Among men younger than 65, after adjusting for other coronary risk factors, the relative risk was 1.72 (95% confidence interval (CI) 1.10-2.69) for men with BMI of 25-28.9, 2.61 (95% CI 1.54-4.42) for BMI of 29.0-32.9, and 3.44 (95% CI 1.67-7.09) for obese men with BMI > or = 33 compared with lean men with BMI or = 65 years of age, the association between BMI and risk of coronary heart disease was much weaker. However, in this age group, the waist-to-hip ratio was a much stronger predictor of risk (relative risk = 2.76, 95% CI 1.22-6.23 between extreme quintiles). These results suggest that for younger men, obesity, independent of fat distribution, is a strong risk factor for coronary heart disease. For older men, measures of fat distribution may be better than body mass index at predicting risk of coronary disease.
Rimm et al. (1995) conducted a cohort in incident coronary heart disease (n=29,122). Body mass index (BMI) and waist-to-hip ratio vs. Lean men (BMI < 23.0) or lowest quintile of waist-to-hip ratio was evaluated on incident coronary heart disease (RR 3.44, 95% CI 1.67-7.09). Obesity (BMI ≥33) was strongly associated with incident coronary heart disease in men <65 years (RR 3.44; 95% CI 1.67-7.09), whereas waist-to-hip ratio was a stronger predictor in men ≥65 years.