A PROSPECTIVE-STUDY OF OBESITY AND RISK OF CORONARY HEART-DISEASE IN WOMEN
A PROSPECTIVE-STUDY OF OBESITY AND RISK OF CORONARY HEART-DISEASE IN WOMEN
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DOI：
10.1056/nejm199003293221303
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发表时间：
1990-03-29
影响因子：
158.5
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
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作者：
MANSON, JAE;COLDITZ, GA;HENNEKENS, CH
我们在一项前瞻性队列研究中检查了非致命性和致命性冠心病的发病率与肥胖的关系，研究对象是1976年年龄在30岁至55岁且未被诊断为冠心病、中风和癌症的115,886名美国女性。在8年(775,430人年)的随访中，我们确定了605例首次冠状动脉事件，其中包括306例非致死性心肌梗死，83例死于冠心病，216例确诊为心绞痛。较高的克托莱指数(体重(公斤)除以身高(米)的平方)与每类冠心病的发生呈正相关。当前Quetlets指数的四个递增级别(<；21至<；23、23至<；25、25至<；29和.29)，经年龄和吸烟调整后，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(Mantel-Extension.chi。For Trend=7.29；P<；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的控制-已知的肥胖症的生物影响-减弱了这种联系的强度。与18岁时相比，目前的克托莱指数是冠状动脉风险的一个更重要的决定因素；介入性的体重增加显著增加了风险。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。在控制吸烟对评估肥胖的真正影响是必不可少的之后，即使是轻度到中度超重也会增加中年女性患冠心病的风险。
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. Four increasing levels of current Quetelet index (< 21, 21 to < 23, 23 to < 25, 25 to < 29, and .gtoreq. 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 < 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 effect of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.