Abdominal and total adiposity and risk of coronary heart disease in men

BACKGROUND: Waist circumference is a simpler measure of abdominal adiposity than waist/hip ratio (WHR), but few studies have directly compared the two measures as predictors of coronary heart disease (CHD) in men. in addition , whether the association of abdominal adiposity is independent of total ad iposity as measured by body mass index (BMI) in men remains uncertain. OBJECTIVE: To compare waist circumference and WHR as predictors of CHD in m en, and to determine whether the association is independent of BMI. DESIGN: Prospective cohort study. METHODS: We compared WHR, waist circumference and BMI with risk of CHD (myo cardial infarction or coronary revascularization) among men in the Physicia ns' Health Study,a randomized trial of aspirin and beta-carotene among 22 0 71 apparently healthy US male physicians, aged 40-84 y at baseline in 1982. Men reported height at baseline, and weight, waist and hip measurements on the 9 y follow-up questionnaire. RESULTS: Among the 16 164 men who reported anthropometric measurements and were free from prior CHD, stroke or cancer, a total of 552 subsequent CHD e vents occurred during an average follow-up of 3.9 y. After adjusting for ag e, randomized study agent, smoking, physical activity, parental history of myocardial infarction, alcohol intake, multivitamin and aspirin use, men in the highest WHR quintile (greater than or equal to 0.99) had a relative ri sk (RR) for CHD of 1.50 (95% CI 1.14-1.98) compared with those in the lowes t quintile (< 0.90). Men in the highest waist circumference quintile (great er than or equal to 103.6 cm) had a RR of 1.60 (CI, 1.21-2.11) for CHD comp ared with men in the lowest quintile (< 88.4 cm). Further adjustment for BM I substantially attenuated these associations: men in the highest WHR and w aist circumference quintiles had relative risks for CHD of 1.23 (CI 0.92-1. 66) and 1.06 (CI, 0.74-1.53), respectively Men in the highest BMI quintile (greater than or equal to 27.6 kg/m(2)) had a multivariate RR of CHD of 1.7 3 (CI, 1.29-2.32), after adjustment for WHR. No significant effect modifica tion by age of the relationship between either measure of abdominal adiposi ty and risk of CHD was observed. CONCLUSIONS: These data support a modest relationship between abdominal adi posity, as measured by either WHR or waist circumference, and risk of CHD b oth in middle-aged and older men. However, abdominal adiposity did not rema in an independent predictor of CHD after adjustment for BMI.