Li Tricia Y, Rana Jamal S, Manson JoAnn E, Willett Walter C, Stampfer Meir J, Colditz Graham A, Rexrode Kathryn M, Hu Frank B
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
Circulation. 2006 Jan 31;113(4):499-506. doi: 10.1161/CIRCULATIONAHA.105.574087.
The comparative importance of physical inactivity and obesity as predictors of coronary heart disease (CHD) risk remains unsettled.
We followed 88 393 women, 34 to 59 years of age, in the Nurses' Health Study from 1980 to 2000. These participants did not have cardiovascular disease and cancer at baseline. We documented 2358 incident major CHD events (including nonfatal myocardial infarction and fatal CHD) during 20 years of follow-up, including 889 cases of fatal CHD and 1469 cases of nonfatal myocardial infarction. In a multivariate model adjusting for cardiovascular risk factors, overweight and obesity were significantly associated with increased risk of CHD, whereas increasing levels of physical activity were associated with a graded reduction in CHD risk (P<0.001). In joint analyses of body mass index (BMI) and physical activity in women who had a healthy weight (BMI, 18.5 to 24.9 kg/m2) and were physically active (exercise > or =3.5 h/wk) as the reference group, the relative risks of CHD were 3.44 (95% confidence interval [CI], 2.81 to 4.21) for women who were obese (BMI > or =30 kg/m2) and sedentary (exercise <1 h/wk), 2.48 (95% CI, 1.84 to 3.34) for women who were active but obese, and 1.48 (95% CI, 1.24 to 1.77) for women who had a healthy weight but were sedentary. In combined analyses of waist-hip ratio and physical activity, both waist-hip ratio and physical activity were significant predictors of CHD, and the highest risk was among women in the lowest category of physical activity and the highest tertile of waist-hip ratio (relative risk=3.03; 95% CI, 1.96 to 4.18). Even a modest weight gain (4 to 10 kg) during adulthood was associated with 27% (95% CI, 12% to 45%) increased risk of CHD compared with women with a stable weight after adjusting for physical activity and other cardiovascular risk factors.
Obesity and physical inactivity independently contribute to the development of CHD in women. These data underscore the importance of both maintaining a healthy weight and regular physical activity in preventing CHD.
缺乏身体活动和肥胖作为冠心病（CHD）风险预测因素的相对重要性仍未确定。
在护士健康研究中，我们对1980年至2000年间年龄在34至59岁的88393名女性进行了随访。这些参与者在基线时没有心血管疾病和癌症。在20年的随访期间，我们记录了2358例主要冠心病事件（包括非致命性心肌梗死和致命性冠心病），其中包括889例致命性冠心病和1469例非致命性心肌梗死。在调整心血管危险因素的多变量模型中，超重和肥胖与冠心病风险增加显著相关，而身体活动水平的提高与冠心病风险的逐步降低相关（P<0.001）。以体重正常（体重指数[BMI]，18.5至24.9kg/m2）且身体活跃（每周锻炼≥3.5小时）的女性作为参照组，对BMI和身体活动进行联合分析，结果显示，肥胖（BMI≥30kg/m2）且久坐不动（每周锻炼<1小时）的女性患冠心病的相对风险为3.44（95%置信区间[CI]，2.81至4.21），身体活跃但肥胖的女性为2.48（95%CI，1.84至3.34），体重正常但久坐不动的女性为1.48（95%CI，1.24至1.77）。在对腰臀比和身体活动进行综合分析时，腰臀比和身体活动都是冠心病的显著预测因素，身体活动水平最低且腰臀比处于最高三分位数的女性风险最高（相对风险=3.03；95%CI，1.96至4.18）。在调整身体活动和其他心血管危险因素后，与体重稳定的女性相比，成年期即使适度体重增加（4至10kg）也与冠心病风险增加27%（95%CI，12%至45%）相关。
肥胖和缺乏身体活动独立地促使女性发生冠心病。这些数据强调了保持健康体重和定期进行身体活动在预防冠心病方面的重要性。
