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

• Published in: International Journal of Obesity Vol. 37; no. 5; pp. 732 - 739
• Main Authors: Hotchkiss, J W, Davies, C A, Leyland, A H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2013; Nature Publishing Group
• Subjects: 692/699/1702/393; 692/699/75; 692/700/478; Adiposity; Adolescent; Adult; Aged; Aged, 80 and over; Alcohol Drinking - mortality; Biological and medical sciences; Body Composition; Body Mass Index; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Coronary Disease - etiology; Coronary Disease - mortality; Coronary Disease - physiopathology; Coronary heart disease; Cross-Sectional Studies; Epidemiology; Female; Follow-Up Studies; General aspects; Genetic aspects; Health aspects; Health hazards; Health Promotion and Disease Prevention; Heart; Humans; Incidence; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Mortality; Obesity; Obesity - complications; Obesity - mortality; Obesity - physiopathology; Original; original-article; Physiological aspects; Polls & surveys; Proportional Hazards Models; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Scotland - epidemiology; Smoking - mortality; Socioeconomic Factors; Statistics; Surveys; Survival Analysis; Waist Circumference; Waist-Hip Ratio; Womens health; United Kingdom; Scotland; Great Britain; Europe; United Kingdom > UK; mortality; Scotland; coronary heart disease; waist–hip ratio; waist circumference; body mass index; Obesity; Adipose tissue; waist-hip ratio; Nutrition; Anthropometry; Mortality; Nutrition disorder; Cardiovascular disease; Metabolic diseases; Corporal biometry; Coronary heart disease; Epidemiology; Statistical study; Body mass index; Waist circumference; Population survey; Association; Adiposity; Cross sectional study; Population; Waist hip ratio; Nutritional status; Public health
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/ijo.2012.102

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.