|
| |
Health
and Wellness Research
|
| Paper
Title |
Obesity and the risk of
myocardial infarction in 27,000 participants from 52 countries: a
case-control study |
| Author(s) |
Salim Yusuf,
Steven Hawken, Stephanie Ôunpuu,
Leonelo Bautista, Maria
Grazia Franzosi, et.al. |
| Journal
Reference |
The
Lancet 2005; 366:1640-1649 |
| 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. |
| Results |
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. |
Authors'
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. |
| Clinical
Significance |
Waist
to hip ratio (WHR), not body mass index (BMI) should be considered the
best obesity measure for assessing a person's risk of cardiovascular
disease (CVD) and heart attack. Women should aim to have a WHR of
less than 0.85 and men less than 0.90 to decrease risk of CVD.
To calculate your WHR simply measure your waist at the height of the
smallest point of the natural waist (usually just superior to the navel)
and divide that value by the measurement of your hips at the largest
prominence of the buttocks. Greater volumes of abdominal fat
correlate to increasing risk of CVD. This may be used as one of many
guidelines to determine healthy weight and body composition for obese
individuals. |
| NOTE:
The clinical significance review is the opinion of Dr Ken Mueller based
upon the information available at the time of posting. Unauthorized
use of that section on clinical significance is prohibited by Canadian
Copyright. The above research abstract is based on information
posted on www.thelancet.com.
For further information, please refer to the original article utilizing
the publication information provided. January 2, 2005 |
|
