Is the burden of overweight on cardiovascular health underestimated?

Body mass index (BMI) was studied for its prediction of cardiovascular diseases (CVD) among 31,000 adult participants in the health examination survey of the Social Insurance Institution of Finland. Mortality, morbidity, and premature work disability from CVD of the participants has been followed up for an average of 10 years by record linkage to the national mortality, hospital discharge, and work invalidity pension registers. The risk of disability and morbidity from CVD increased linearly with BMI, but mortality was only weakly related to BMI. After adjustment for age, smoking, and occupation, the relative risks of work disability, morbidity, and mortality from CVD for women with BMI greater than or equal to 30 kg/m2 were, respectively, 2.6 (95% confidence interval = 1.8-3.8), 1.9 (1.4-2.3) and 1.4 (0.7-2.7), compared with the risks for women with BMI less than 22.5 kg/m2. The corresponding risks for men were 2.0 (1.5-2.5), 1.8 (1.5-2.1), and 1.4 (1.0-1.8), respectively. The high risks were largely due to an excess of CVD other than myocardial infarction and stroke. Because of the associated nonfatal morbidity and disability, overweight remains a major preventable risk factor of CVD. CVD in the obese may have a lower than average fatality rate.