ArticlesObesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study
Introduction
Obesity increases the risk of cardiovascular diseases and diabetes,1, 2 but these data are derived mainly from high-income countries. Although most of the global burden of cardiovascular disease is in developing countries, few data are available for the effect of obesity in these populations.3 Further, we do not know the measure of obesity (body-mass index [BMI], waist or hip circumferences, or waist-to-hip ratio) that shows the strongest relation to the risk of such disease and whether these measures are similar across different ethnic groups, in men and women, and at different ages.4 Previous studies provided conflicting results, possibly because of the modest number of cardiovascular events (a few hundred).5, 6, 7, 8, 9
On the basis of two previous smaller studies,10, 11 we had postulated that markers of central obesity (especially the waist-to-hip ratio) would be more strongly related to the risk of myocardial infarction than BMI (the conventional measure). We aimed to investigate the relation of BMI, waist and hip circumferences, and waist-to-hip ratio to the risk of myocardial infarction using data from the INTERHEART study,12, 13 of about 15 000 cases and a similar number of controls representing many ethnic groups.
Section snippets
Participants
We did a standardised case-control study of 15 152 cases of first myocardial infarction, and 14 820 age-matched and sex-matched controls. Details have been published previously.5 Consecutive cases of first myocardial infarction presenting within 24 h of symptom onset were eligible. All consenting cases without cardiogenic shock or history of major chronic diseases were included. At least one age-matched (±5 years) and sex-matched control (without a history of cardiovascular disease) was
Results
A total of 27 098 participants (12 461 cases and 14 637 age-matched and sex-matched controls) were included in these analyses. The distribution of various risk factors between cases and controls has been reported previously5 (webtable 1); here we focus only on measures related to obesity. There was no significant difference in height between cases and controls. The mean BMI in controls was 25·8 kg/m2, (95% CI; 25·8–25·9); 25·6 kg/m2 (25·5–25·7) in men and 26·5 kg/m2 (26·4–26·7) in women (
Discussion
The INTERHEART study clearly indicates that of the various anthropometric measures commonly used, waist-to-hip ratio shows the strongest relation with the risk of myocardial infarction worldwide. This ratio was the strongest anthropometric predictor of myocardial infarction in men and women, across all age and ethnic groups, in smokers and in non-smokers (potential effect modifier), and in those with or without dyslipidaemia, diabetes, or hypertension (which are consequences of obesity). By
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