Body mass index and metabolic risk factors for coronary heart disease in women

Aims Prospective epidemiological studies demonstrate an increase in coronar y heart disease mortality in women beginning at values of body mass index g reater than or equal to 22 kg.m(-2) However, the metabolic basis for this o bservation has not been adequately studied in women. Our aim was to examine the association between body mass index, metabolic coronary heart disease risk factors and a predicted 10-year coronary heart disease risk score in a large occupational cohort of women in the U.K. Methods and Results We carried out a cross-sectional survey of cardiovascul ar risk factors in 14 077 women, aged 30-64 years. The main outcome measure s were systolic and diastolic blood pressure, serum total cholesterol, HDL cholesterol, total cholesterol/HDL cholesterol ratio, LDL-cholesterol, trig lycerides, apolipoprotein Al, apolipoprotein B, lipoprotein(a), fasting blo od glucose and a predicted 10-year coronary risk score. Across seven catego ries of body mass index, i.e. <20, 20-, 22-, 24-, 26-, 28- and 230 kg. m (- 2), there were highly significant age-adjusted increases in the risk factor s (all P<0.001), except for a decrease in HDL cholesterol and ApoA1 (all P< 0.001) and no relationship with lipoprotein(a) (P=005). Based on a multifac torial 10-year coronary heart disease risk estimate, odds ratios for being in the highest quintile of risk for each category of body mass index, were 1 (<20 kg. m(-2)), 0.91, 1.56, 2.18, 2.97, 3.83 and 4.21 (greater than or e qual to 30 kg.m(- 2)). Conclusions The significant rise in metabolic coronary heart disease risk a t 22 kg. m(-2) observed in this study is consistent with prospective epidem iological studies in women which have reported an increase in coronary hear t disease mortality starting at 22 kg. m-2. However, body mass index was a poor discriminator of women at different levels of coronary heart disease r isk. The primary goal of weight loss in individuals should be the correctio n of dysmetabolism, irrespective of the level of body mass index. (Eur Hear t J 2001; 22: 36-55, doi:10.10531euhj.2000.2469) (C) 2001 The European Soci ety of Cardiology.