Manson J E, Colditz G A, Stampfer M J, Willett W C, Rosner B, Monson R R, Speizer F E, Hennekens C H
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, MA.
N Engl J Med. 1990 Mar 29;322(13):882-9. doi: 10.1056/NEJM199003293221303.
We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.
在一项针对115886名美国女性的前瞻性队列研究中，我们研究了非致命性和致命性冠心病的发病率与肥胖之间的关系。这些女性在1976年年龄为30至55岁，且无确诊的冠心病、中风和癌症。在八年的随访期（775430人年）内，我们确定了605例首次冠心病事件，包括306例非致命性心肌梗死、83例冠心病死亡以及216例确诊的心绞痛病例。较高的奎特莱指数（体重千克数除以身高米数的平方）与各类冠心病的发生呈正相关。对于当前奎特莱指数不断升高的情况（小于21、21至小于23、23至小于25、25至小于29以及大于或等于29），经年龄和吸烟因素调整后，非致命性心肌梗死和致命性冠心病合并的相对风险分别为1.0、1.3、1.3、1.8和3.3（趋势的曼特尔扩展卡方检验=7.29；P小于0.00001）。正如预期的那样，对高血压、糖尿病和高胆固醇血症病史（已知为肥胖的生物学效应）进行控制后，关联强度减弱。当前的奎特莱指数比18岁时的该指数更能决定冠心病风险；其间体重增加会大幅增加风险。这些前瞻性数据强调了肥胖作为女性冠心病决定因素的重要性。在控制吸烟（这对于评估肥胖的真正影响至关重要）后，即使是轻度至中度超重也会增加中年女性患冠心病的风险。
