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Adiposity has differing associations with incident coronary heart disease and mortality in the Scottish population: cross-sectional surveys with follow-up.

Abstract

OBJECTIVE

Investigation of the association of excess adiposity with three different outcomes: all-cause mortality, coronary heart disease (CHD) mortality and incident CHD.

DESIGN

Cross-sectional surveys linked to hospital admissions and death records.

SUBJECTS

19 329 adults (aged 18-86 years) from a representative sample of the Scottish population.

MEASUREMENTS

Gender-stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, CHD mortality and incident CHD. Separate models incorporating the anthropometric measurements body mass index (BMI), waist circumference (WC) or waist-hip ratio (WHR) were created adjusted for age, year of survey, smoking status and alcohol consumption.

RESULTS

For both genders, BMI-defined obesity (30 kg m(-2)) was not associated with either an increased risk of all-cause mortality or CHD mortality. However, there was an increased risk of incident CHD among the obese men (hazard ratio (HR)=1.78; 95% confidence interval=1.37-2.31) and obese women (HR=1.93; 95% confidence interval=1.44-2.59). There was a similar pattern for WC with regard to the three outcomes; for incident CHD, the HR=1.70 (1.35-2.14) for men and 1.71 (1.28-2.29) for women in the highest WC category (men 102 cm, women 88 cm), synonymous with abdominal obesity. For men, the highest category of WHR (1.0) was associated with an increased risk of all-cause mortality (1.29; 1.04-1.60) and incident CHD (1.55; 1.19-2.01). Among women with a high WHR (0.85) there was an increased risk of all outcomes: all-cause mortality (1.56; 1.26-1.94), CHD mortality (2.49; 1.36-4.56) and incident CHD (1.76; 1.31-2.38).

CONCLUSIONS

In this study excess adiposity was associated with an increased risk of incident CHD but not necessarily death. One possibility is that modern medical intervention has contributed to improved survival of first CHD events. The future health burden of increased obesity levels may manifest as an increase in the prevalence of individuals living with CHD and its consequences.

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  • Authors+Show Affiliations

    ,

    MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK. joel.hotchkiss@sphsu.mrc.ac.uk

    ,

    Source

    MeSH

    Adiposity
    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Alcohol Drinking
    Body Composition
    Body Mass Index
    Coronary Disease
    Cross-Sectional Studies
    Female
    Follow-Up Studies
    Humans
    Incidence
    Male
    Middle Aged
    Obesity
    Proportional Hazards Models
    Risk Factors
    Scotland
    Smoking
    Socioeconomic Factors
    Survival Analysis
    Waist Circumference
    Waist-Hip Ratio

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22751254

    Citation

    Hotchkiss, J W., et al. "Adiposity Has Differing Associations With Incident Coronary Heart Disease and Mortality in the Scottish Population: Cross-sectional Surveys With Follow-up." International Journal of Obesity (2005), vol. 37, no. 5, 2013, pp. 732-9.
    Hotchkiss JW, Davies CA, Leyland AH. Adiposity has differing associations with incident coronary heart disease and mortality in the Scottish population: cross-sectional surveys with follow-up. Int J Obes (Lond). 2013;37(5):732-9.
    Hotchkiss, J. W., Davies, C. A., & Leyland, A. H. (2013). Adiposity has differing associations with incident coronary heart disease and mortality in the Scottish population: cross-sectional surveys with follow-up. International Journal of Obesity (2005), 37(5), pp. 732-9. doi:10.1038/ijo.2012.102.
    Hotchkiss JW, Davies CA, Leyland AH. Adiposity Has Differing Associations With Incident Coronary Heart Disease and Mortality in the Scottish Population: Cross-sectional Surveys With Follow-up. Int J Obes (Lond). 2013;37(5):732-9. PubMed PMID: 22751254.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Adiposity has differing associations with incident coronary heart disease and mortality in the Scottish population: cross-sectional surveys with follow-up. AU - Hotchkiss,J W, AU - Davies,C A, AU - Leyland,A H, Y1 - 2012/07/03/ PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2014/2/19/medline SP - 732 EP - 9 JF - International journal of obesity (2005) JO - Int J Obes (Lond) VL - 37 IS - 5 N2 - OBJECTIVE: Investigation of the association of excess adiposity with three different outcomes: all-cause mortality, coronary heart disease (CHD) mortality and incident CHD. DESIGN: Cross-sectional surveys linked to hospital admissions and death records. SUBJECTS: 19 329 adults (aged 18-86 years) from a representative sample of the Scottish population. MEASUREMENTS: Gender-stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, CHD mortality and incident CHD. Separate models incorporating the anthropometric measurements body mass index (BMI), waist circumference (WC) or waist-hip ratio (WHR) were created adjusted for age, year of survey, smoking status and alcohol consumption. RESULTS: For both genders, BMI-defined obesity (30 kg m(-2)) was not associated with either an increased risk of all-cause mortality or CHD mortality. However, there was an increased risk of incident CHD among the obese men (hazard ratio (HR)=1.78; 95% confidence interval=1.37-2.31) and obese women (HR=1.93; 95% confidence interval=1.44-2.59). There was a similar pattern for WC with regard to the three outcomes; for incident CHD, the HR=1.70 (1.35-2.14) for men and 1.71 (1.28-2.29) for women in the highest WC category (men 102 cm, women 88 cm), synonymous with abdominal obesity. For men, the highest category of WHR (1.0) was associated with an increased risk of all-cause mortality (1.29; 1.04-1.60) and incident CHD (1.55; 1.19-2.01). Among women with a high WHR (0.85) there was an increased risk of all outcomes: all-cause mortality (1.56; 1.26-1.94), CHD mortality (2.49; 1.36-4.56) and incident CHD (1.76; 1.31-2.38). CONCLUSIONS: In this study excess adiposity was associated with an increased risk of incident CHD but not necessarily death. One possibility is that modern medical intervention has contributed to improved survival of first CHD events. The future health burden of increased obesity levels may manifest as an increase in the prevalence of individuals living with CHD and its consequences. SN - 1476-5497 UR - https://www.unboundmedicine.com/medline/citation/22751254/Adiposity_has_differing_associations_with_incident_coronary_heart_disease_and_mortality_in_the_Scottish_population:_cross_sectional_surveys_with_follow_up_ L2 - http://dx.doi.org/10.1038/ijo.2012.102 DB - PRIME DP - Unbound Medicine ER -