June 10, 2008Open Access
View Full PaperObesity, Behavioral Lifestyle Factors, and Risk of Acute Coronary Events
Structured PICO
Do behavioral lifestyle factors reduce the impact of obesity on the risk of acute coronary events in adults free of coronary artery disease?
P
Population
54,783 women and men aged 50 to 64 years at baseline, free of coronary artery disease and cancer, from the prospective Danish Diet, Cancer and Health study.
I
Intervention
Obesity (BMI ≥30 kg/m²) and overweight (BMI 25 to 29.9 kg/m²) combined with various behavioral lifestyle factors (physical activity, smoking status, dietary pattern).
C
Comparator
Normal weight and different lifestyle behavior subgroups (e.g., sedentary, smokers, less healthy diet).
O
Outcome
Incident cases of acute coronary syndrome (ACS) during a median of 7.7 years.hard clinical
Obesity independently increases the risk of acute coronary syndrome across all lifestyle subgroups, although adherence to healthy behaviors still lowers the absolute risk among obese individuals.
Abstract
BACKGROUND: Whether physical activity reduces the impact of obesity on the risk of acute coronary events is much debated. However, little is known about the role of other potentially modifiable lifestyle factors in combination with obesity. METHODS AND RESULTS: We followed up 54,783 women and men from the prospective Danish Diet, Cancer and Health study who were 50 to 64 years at baseline (1993 to 1997) and free of coronary artery disease and cancer. During a median of 7.7 years, 1127 incident cases of acute coronary syndrome (ACS) occurred. After multivariable adjustments, each unit of body mass index was associated with a 5% and 7% higher risk of ACS among women and men, respectively (both Por=30 kg/m(2)) were associated with a higher risk of ACS among the physically active and inactive, in nonsmokers and smokers, and among those who adhered more or less to a heart-healthy dietary pattern. Obese individuals who were active 1 to 3.5 h/wk had a lower risk than sedentary, obese individuals. In addition, obese nonsmokers had a lower risk than obese smokers. Adherence to a healthy diet was associated with a lower risk of ACS; however, the relative risk was not different among obese individuals with the most healthy diet versus obese individuals with a less healthy diet. CONCLUSIONS: Obesity confers an elevated risk of ACS in both healthy and less healthy subgroups of lifestyle behaviors. Adherence to healthy lifestyle behaviors was associated with a lower risk even among obese individuals.