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Impact of abdominal obesity and systemic hypertension on risk of coronary heart disease in men and women: the EPIC-Norfolk Population Study

Rhéaume, Carolinea,b; Arsenault, Benoit J.a,c; Després, Jean-Pierre; Fahaa,d; Boekholdt, S. Matthijse; Wareham, Nicholas J.f; Khaw, Kay-Tee; Chir, Mbbg

doi: 10.1097/HJH.0000000000000307

Background: The objective of our study was to determine the respective contributions of waist circumference and systemic hypertension (HTN) to coronary heart disease (CHD) risk in a large population-based cohort representative of a contemporary European population.

Methods and results: A total of 9580 men and 12 250 women aged 45–79 years were followed for 11.4 years. Over the follow-up, 2191 CHD events were recorded. After adjusting for traditional CHD risk factors, individuals with high blood pressure (BP) and high waist circumference were at an increased CHD risk [hazard ratio 3.04; 95% confidence interval (CI) 2.06–4.48 and 2.90 (1.85–4.55) in men and women, respectively], compared with individuals with both low waist circumference and BP. Among individuals with normal BP, those in the top waist circumference tertile were at an increased CHD risk compared with those in the bottom waist circumference tertile (hazard ratio 2.66; 95% CI 1.59–4.45 and 2.11; 95% CI 1.12–3.97 in men and women, respectively). Within each physical activity category, a linear positive association was observed between waist circumference tertiles and both SBP (P for trend <0.001) and DBP (P for trend <0.001). Within each waist circumference tertile, inactive individuals had higher SBP than active individuals (P for trend <0.001).

Conclusion: Our results show that abdominal obesity (measured by waist circumference) and HTN had both independent and additive contributions to CHD risk. We also found that physical inactivity and abdominal obesity contribute to elevated BP in primary prevention settings.

aCentre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City

bDepartment of Family Medicine and Emergency Medicine

cDepartment of Medicine

dDepartment of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada

eDepartment of Cardiology, Academic Medical Center, Amsterdam, the Netherlands

fMedical Research Council Epidemiology Unit

gDepartment of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK

Correspondence to Caroline Rhéaume, MD, PhD, CFPC, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725, Chemin Ste-Foy, Pavilion Marguerite-D’Youville, 2th Floor, QC G1 V 4G5, Canada. Tel: +1 418 656 4863; fax: +1 418 656 4610; e-mail:

Abbreviations: BP, blood pressure; CHD, coronary heart disease; CRF, cardiorespiratory fitness; EPIC, European Prospective Investigation into Cancer and Nutrition; HDL-C, high-density lipoprotein cholesterol; HTN, systemic hypertension; ICD, International Classification for Diseases; LDL-C, low-density lipoprotein cholesterol

Received 13 January, 2014

Revised 11 June, 2014

Accepted 11 June, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins