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British Medical Journal

News & Views

Obesity independent CHD risk factor

The increased risk of death from coronary heart disease (CHD) brought on by obesity remains constant regardless of other risk factors, according to research recently published online at

Even after adjusting for all traditional cardiovascular risk factors, men with a body mass index (BMI) of 30 and above faced a 60% increased risk for fatal CHD events, according to the authors led by Jennifer Logue, clinical lecturer with the British Heart Foundation’s Cardiovascular Research Centre at the University of Glasgow.

The results were drawn from the West of Scotland Coronary Prevention Study (WOSCOPS), which surveyed the BMI of 6,082 men (mean age 55 years) with hypercholesterolaemia, but no history of diabetes or cardiovascular disease (CVD). BMI was related to the risk of fatal and non-fatal CHD events – after excluding participants with any event in the first 2 years, 1,027 non-fatal and 214 fatal CHD events occurred during 14.7 years of follow-up.

A minimally adjusted model (age, sex, statin treatment) and a maximally adjusted model (including known CVD risk factors and deprivation) were compared, with BMI 25–27.4 kg/m2 as referent. The risk of non-fatal events was similar across all BMI categories in both models. The risk of fatal CHD events was increased in men with BMI 30.0–39.9 kg/m2 in both the minimally adjusted model (HR=1.75 (95% CI 1.12 to 2.74)) and the maximally adjusted model (HR=1.60 (95% CI 1.02 to 2.53)).

Although the effect of BMI on CHD risk is attenuated when mediators such as diabetes, hypertension and hyperlipidaemia are accounted for, the report asserts that there is “a differential effect of risk factors on fatal and non-fatal CHD events, with markers of inflammation more strongly associated with fatal than non-fatal events”.

The authors note that the connection may relate to inflammation, a strong factor in fatal CVD which is increasingly recognized as linked to obesity. They also see it as reaffirmation that “researchers should consider investigation of fatal and non-fatal events separately rather than assuming a common aetiology”.

“Future work is required to examine the relationship between BMI and CHD events, fatal and non-fatal, in a range of populations”. They also observe that the long timeframe of their research may have influenced its results, obesity having become far more widespread in recent years – “more recent studies will have a higher prevalence of obesity in which to gain the power required to study these associations”.


  1. Logue J, Murray HM, Welsh P, et al. Obesity is associated with fatal coronary heart disease independently of traditional risk factors and deprivation. Heart 2011;DOI:10.1136/hrt.2010.211201. Available at:

Published on: March 3, 2011

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