Document Detail


Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.
MedLine Citation:
PMID:  16271645     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Obesity is a major risk factor for cardiovascular disease, but the most predictive measure for different ethnic populations is not clear. We aimed to assess whether markers of obesity, especially waist-to-hip ratio, would be stronger indicators of myocardial infarction than body-mass index (BMI), the conventional measure. METHODS: We did a standardised case-control study of acute myocardial infarction with 27 098 participants in 52 countries (12,461 cases and 14,637 controls) representing several major ethnic groups. We assessed the relation between BMI, waist and hip circumferences, and waist-to-hip ratio to myocardial infarction overall and for each group. FINDINGS: BMI showed a modest and graded association with myocardial infarction (OR 1.44, 95% CI 1.32-1.57 top quintile vs bottom quintile before adjustment), which was substantially reduced after adjustment for waist-to-hip ratio (1.12, 1.03-1.22), and non-significant after adjustment for other risk factors (0.98, 0.88-1.09). For waist-to-hip ratio, the odds ratios for every successive quintile were significantly greater than that of the previous one (2nd quintile: 1.15, 1.05-1.26; 3rd quintile: 1.39; 1.28-1.52; 4th quintile: 1.90, 1.74-2.07; and 5th quintiles: 2.52, 2.31-2.74 [adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1.77; 1.59-1.97) and hip (0.73; 0.66-0.80) circumferences were both highly significant after adjustment for BMI (p<0.0001 top vs bottom quintiles). Waist-to-hip ratio and waist and hip circumferences were closely (p<0.0001) associated with risk of myocardial infarction even after adjustment for other risk factors (ORs for top quintile vs lowest quintiles were 1.75, 1.33, and 0.76, respectively). The population-attributable risks of myocardial infarction for increased waist-to-hip ratio in the top two quintiles was 24.3% (95% CI 22.5-26.2) compared with only 7.7% (6.0-10.0) for the top two quintiles of BMI. INTERPRETATION: Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio instead of BMI increases the estimate of myocardial infarction attributable to obesity in most ethnic groups.
Authors:
Salim Yusuf; Steven Hawken; Stephanie Ounpuu; Leonelo Bautista; Maria Grazia Franzosi; Patrick Commerford; Chim C Lang; Zvonko Rumboldt; Churchill L Onen; Liu Lisheng; Supachai Tanomsup; Paul Wangai; Fahad Razak; Arya M Sharma; Sonia S Anand;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  366     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-07     Completed Date:  2005-12-01     Revised Date:  2010-09-14    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1640-9     Citation Subset:  AIM; IM    
Affiliation:
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada. yusufs@mcmaster.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Body Mass Index
Case-Control Studies
Female
Humans
Male
Myocardial Infarction / etiology*
Obesity / complications*,  epidemiology
Risk Factors
Waist-Hip Ratio*
World Health*
Comments/Corrections
Comment In:
Lancet. 2005 Nov 5;366(9497):1589-91   [PMID:  16271629 ]
Lancet. 2006 Apr 1;367(9516):1051-2; author reply 1054   [PMID:  16581394 ]
Lancet. 2006 Apr 1;367(9516):1052; author reply 1054   [PMID:  16581395 ]
Lancet. 2006 Apr 1;367(9516):1053; author reply 1054   [PMID:  16581397 ]
Lancet. 2006 Apr 1;367(9516):1053-4; author reply 1054   [PMID:  16581396 ]
Lancet. 2010 Sep 11;376(9744):873-4; author reply 874   [PMID:  20833300 ]

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