TY - JOUR
T1 - Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries
T2 - a case-control study
AU - Yusuf, Salim
AU - Hawken, Steven
AU - Ounpuu, Stephanie
AU - Bautista, Leonelo
AU - Franzosi, Maria Grazia
AU - Commerford, Patrick
AU - Lang, Chim C.
AU - Rumboldt, Zvonko
AU - Onen, Churchill L.
AU - Lisheng, Liu
AU - Tanomsup, Supachai
AU - Wangai, Paul
AU - Razak, Fahad
AU - Sharma, Arya M.
AU - Anand, Sonia S.
N1 - dc.publisher: Elsevier
The article references also includes three 'Web Extra material' PDF's : Webtable 1. Demographics and prevalence of risk factors in cases and controls in the INTERHEART study.; Webtable 2. Anthropometric measures by region.; INTERHEART Project Office Staff, National Coordinators, and Investigators.
PY - 2005
Y1 - 2005
N2 - 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.
AB - 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.
KW - Obesity
KW - Myocardial infarction
KW - Cardiovascular disease
KW - Ethnic groups
U2 - 10.1016/S0140-6736(05)67663-5
DO - 10.1016/S0140-6736(05)67663-5
M3 - Article
C2 - 16271645
SN - 0140-6736
VL - 366
SP - 1640
EP - 1649
JO - Lancet
JF - Lancet
IS - 9497
ER -
