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Upper-body adiposity and risk of myocardial infarction
A Azevedo1, E Ramos, P von Hafe
1Department of Hygiene and Epidemiology, University of Porto Medical School, Portugal. mistamp@mail.telepac.pt
Insights
Upper-body fat distribution, not just body mass index (BMI), is a significant predictor of acute myocardial infarction (AMI) risk. This finding highlights the importance of fat distribution in assessing coronary heart disease (CHD) risk.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The link between obesity and coronary heart disease (CHD) remains inconclusive despite extensive research.
- Upper-body adiposity is increasingly recognized as a superior predictor of CHD compared to general obesity measures.
Purpose of the Study:
- To evaluate the association between upper-body fat distribution and the risk of acute myocardial infarction (AMI).
- To determine if waist-to-hip ratio is a better predictor of AMI than body mass index (BMI).
Main Methods:
- A community-based case-control study involving 338 AMI patients and 662 controls.
- Body mass index (BMI) and waist-to-hip ratio were assessed, categorized into tertiles based on control group distributions.
- Unconditional logistic regression was used to estimate odds ratios (OR) for AMI risk, with separate analyses for men and women.
Main Results:
- Higher waist-to-hip ratio was strongly associated with increased AMI risk in both men and women, even within lower BMI categories.
- For men, the adjusted OR for AMI increased from 2.5 (second tertile) to 11.1 (third tertile) with higher waist-to-hip ratios.
- For women, the adjusted OR for AMI increased from 3.0 (second tertile) to 14.1 (third tertile) with higher waist-to-hip ratios.
Conclusions:
- Waist-to-hip ratio, reflecting upper-body fat distribution, is a potent marker for AMI risk.
- Body fat distribution, rather than BMI alone, is a critical factor in assessing coronary heart disease risk.
- A significant interaction exists between body fat distribution and BMI in predicting AMI risk.
Background:
The relation between obesity and coronary heart disease (CHD) has long been studied, but no convincing conclusion has been drawn.
Objective:
To estimate the relative risk associated with upper-body adiposity which is at present believed to be a better predictor of CHD.
Design:
This was a community-based case-control study.
Methods:
We studied 338 consecutively admitted patients who had had their first acute myocardial infarction (AMI) and 662 community controls who had not suffered AMI selected as a random sample of adults living in the catchment area of the hospital. We defined three classes of body mass index (BMI) and waist: hip circumference ratio on the basis of tertiles of distribution for controls. Odds ratios (OR) were estimated using unconditional logistic regression. Separate models were built for men and women.
Results:
In univariate analysis we found a higher risk of AMI for men and women with hypertension, dyslipidaemia, diabetes and lower levels of education, for older women, for male smokers and for men with family histories of CHD. Both for men and for women a higher BMI was associated with a slightly higher risk, whereas the adjusted risk of AMI increased with increasing waist: hip circumference ratio [for men OR (second tertile)= 2.5, 95% confidence interval (CI) 1.3-4.9 and OR (third tertile)= 11.1, 95% CI 6.0-20.6; for women OR (second tertile) = 3.0, 95% CI 0.6-14.8 and OR (third tertile) = 14.1,95% CI 3.2-62.7]. This relation held for each BMI class and was stronger for classes of lower BMI.
Conclusions:
Distribution of body fat rather than BMI is a strong marker of risk for AMI and there is a clear interaction between these two variables.