Abdominal Adiposity and Coronary Heart Disease in Women
1998
Context.—Obesity is a well-established risk factor
for coronary heart disease (CHD), but whether regional fat distribution
contributes independently to risk remains unclear.Objective.—To compare waist-hip ratio (WHR) and waist
circumference in determining risk of CHD in women.Design and Setting.—Prospective cohort study among US
female registered nurses participating in the Nurses' Health Study
conducted between 1986, when the nurses completed a questionnaire, and
follow-up in June 1994.Participants.—A total of 44,702 women aged 40 to 65
years who provided waist and hip circumferences and were free of prior
CHD, stroke, or cancer in 1986.Main Outcome Measures.—Incidence of CHD (nonfatal
myocardial infarction or CHD death).Results.—During 8 years of follow-up 320 CHD events (251
myocardial infarctions and 69 CHD deaths) were documented. Higher WHR
and greater waist circumference were independently associated with a
significantly increased age-adjusted risk of CHD. After adjusting for
body mass index (BMI) (defined as weight in kilograms divided by the
square of height in meters) and other cardiac risk factors, women with
a WHR of 0.88 or higher had a relative risk (RR) of 3.25 (95%
confidence interval [CI], 1.78-5.95) for CHD compared with women with
a WHR of less than 0.72. A waist circumference of 96.5 cm (38 in) or
more was associated with an RR of 3.06 (95% CI, 1.54-6.10). The WHR
and waist circumference were independently strongly associated with
increased risk of CHD also among women with a BMI of 25
kg/m2 or less. After adjustment for reported hypertension,
diabetes, and high cholesterol level, a WHR of 0.76 or higher or waist
circumference of 76.2 cm (30 in) or more was associated with more than
a 2-fold higher risk of CHD.Conclusions.—The WHR and waist circumference are
independently associated with risk of CHD in
women.
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