University of Oxford, Oxford, UK.
Eur J Prev Cardiol. 2013 Oct;20(5):759-62. doi: 10.1177/2047487313492631. Epub 2013 May 30.
High body mass index (BMI) and large waist circumference are separately associated with increased coronary heart disease (CHD) risk but these measures are highly correlated. Their separate associations with incident CHD, cross-classifying one variable by the other, are less investigated in large-scale studies. We examined these associations in a large UK cohort (the Million Women Study), which is a prospective population-based study. We followed 496,225 women (mean age 60 years) with both waist circumference and BMI measurements who had no vascular disease or cancer. Adjusted relative risk and 20-year cumulative CHD incidence (first coronary hospitalization or death) from age 55 to 74 years were calculated using Cox regression. Plasma apolipoproteins were assayed in 6295 randomly selected participants. There were 10,998 incident coronary events after mean follow up of 5.1 years. Within each BMI category (<25, 25-29.9, ≥30 kg/m(2)), CHD risk increased with increasing waist circumference; within each waist circumference category (<70, 70-79.9, ≥79 cm), CHD risk increased with increasing BMI. The cumulative CHD incidence was lowest in women with BMI <25 kg/m(2) and waist circumference <70 cm, with 1 in 14 (95% confidence interval 1 in 12 to 16) women developing CHD in the 20 years from age 55 to 74 years, and highest in women with BMI ≥30 kg/m(2) and waist circumference ≥80 cm, with 1 in 8 (95% confidence interval 1 in 7 to 9) women developing CHD over the same period. Similar associations for apolipoprotein B to A1 ratio across adiposity categories were observed, particularly in non-obese women. Our conclusions were that both waist circumference and BMI are independently associated with incident CHD.
高身体质量指数（BMI）和大腰围分别与增加的冠心病（CHD）风险相关，但这些措施高度相关。在大规模研究中，较少研究它们通过其他变量交叉分类的与 CHD 事件的单独关联。我们在一个大型英国队列（百万妇女研究）中检查了这些关联，这是一项前瞻性的基于人群的研究。我们随访了 496225 名既有腰围又有 BMI 测量值的女性（平均年龄 60 岁），这些女性没有血管疾病或癌症。使用 Cox 回归计算了年龄在 55 岁至 74 岁之间从年龄 55 岁到 74 岁的调整后的相对风险和 20 年累积 CHD 发病率（首次冠状动脉住院或死亡）。在 6295 名随机选择的参与者中测定了血浆载脂蛋白。在平均随访 5.1 年后，发生了 10998 例冠心病事件。在每个 BMI 类别（<25、25-29.9、≥30 kg/m2）内，随着腰围的增加，CHD 风险增加；在每个腰围类别（<70、70-79.9、≥79 cm）内，随着 BMI 的增加，CHD 风险增加。BMI<25 kg/m2 和腰围<70 cm 的女性的 CHD 累积发病率最低，14 名（95%置信区间为 12 至 16）女性在 55 岁至 74 岁的 20 年内发生 CHD，BMI≥30 kg/m2 和腰围≥80 cm 的女性最高，在同一时期，每 8 名（95%置信区间为 7 至 9）女性发生 CHD。在肥胖类别中观察到载脂蛋白 B 与 A1 比值的类似关联，尤其是在非肥胖女性中。我们的结论是，腰围和 BMI 均与 CHD 事件的发生独立相关。
