Obesity as Compared With Physical Activity in Predicting Risk of Coronary Heart Disease in Women

Abstract

Background-The comparative importance of physical inactivity and obesity as predictors of coronary heart disease (CHD) risk remains unsettled. Methods and Results-We followed 88 393 women, 34 to 59 years of age, in the Nurses' Health Study from 1980 to 2000.These participants did not have cardiovascular disease and cancer at baseline. We documented 2358 incident major CHD events (including nonfatal myocardial infarction and fatal CHD) during 20 years of follow-up, including 889 cases of fatal CHD and 1469 cases of nonfatal myocardial infarction. In a multivariate model adjusting for cardiovascular risk factors, overweight and obesity were significantly associated with increased risk of CHD, whereas increasing levels of physical activity were associated with a graded reduction in CHD risk (PϽ0.001). In joint analyses of body mass index (BMI) and physical activity in women who had a healthy weight (BMI, 18.5 to 24.9 kg/m 2 ) and were physically active (exercise Ն3.5 h/wk) as the reference group, the relative risks of CHD were 3.44 (95% confidence interval [CI], 2.81 to 4.21) for women who were obese (BMI Ն30 kg/m 2 ) and sedentary (exercise Ͻ1 h/wk), 2.48 (95% CI, 1.84 to 3.34) for women who were active but obese, and 1.48 (95% CI, 1.24 to 1.77) for women who had a healthy weight but were sedentary. In combined analyses of waist-hip ratio and physical activity, both waist-hip ratio and physical activity were significant predictors of CHD, and the highest risk was among women in the lowest category of physical activity and the highest tertile of waist-hip ratio (relative riskϭ3.03; 95% CI, 1.96 to 4.18). Even a modest weight gain (4 to 10 kg) during adulthood was associated with 27% (95% CI, 12% to 45%) increased risk of CHD compared with women with a stable weight after adjusting for physical activity and other cardiovascular risk factors. Conclusions-Obesity and physical inactivity independently contribute to the development of CHD in women. These data underscore the importance of both maintaining a healthy weight and regular physical activity in preventing CHD.

Hypertriglyceridemic waist: A useful screening phenotype in preventive cardiology?

“…Moreover, the CAD event rate of obese women not characterized by abdominal obesity was essentially similar to what was recorded among nonobese women with an elevated waist circumference. A longer follow-up of the Nurses' Health Study (20 years) yielded similar results (34). Finally, in the landmark international cross-sectional, casecontrol INTERHEART study, involving more than 27,000 individuals stratified on the basis of their BMI values and WHR, subjects in the top quintiles of WHR were characterized by an increased odds ratio of MI irrespective of the BMI category considered (35).…”

Physical activity, Body Mass Index and health care costs in mid‐age Australian women

“…11 In the United States (US), it has been shown that health care costs are inversely associated with PA, after adjustment for Body Mass Index (BMI), 12 and it is estimated that health care costs are $US300 per person per year less for regularly active than for sedentary adults. 13 As it is now well established that weightrelated health problems are ameliorated by regular PA 14 17 As 78.5% of the participants in that study were men, the cost savings for women are less clear. The aims of this study were therefore to quantify relationships between PA, BMI and Medicare costs in a cohort of midage Australian women and to estimate the potential population cost savings associated with increasing PA and decreasing BMI in sedentary women.…”

“…11 In the United States (US), it has been shown that health care costs are inversely associated with PA, after adjustment for Body Mass Index (BMI), 12 and it is estimated that health care costs are $US300 per person per year less for regularly active than for sedentary adults. 13 As it is now well established that weightrelated health problems are ameliorated by regular PA 14 and increased levels of fitness, 15 it might be expected that health costs would be lower in physically active people, regardless of BMI. However, most studies in this area have reported separately on the costs of inactivity and overweight/obesity 16 and few have reported costs associated with the combined effects of these risk factors.…”

Is the Environment Near Home and School Associated with Physical Activity and Adiposity of Urban Preschool Children?

“…Strategies to promote childhood physical activity are becoming a public health priority, 1,2 both because an active lifestyle has direct health benefits, [3][4][5][6] and because physical activity plays a role in preventing obesity. 7,8 Childhood activity patterns may be particularly important if they persist into adulthood.…”