CARDIOVASCULAR MEDICINE

Obesity and overweight in relation to disease-specific mortality in men with and without existing coronary heart disease in London: the original Whitehall study

G D Batty¹, M J Shipley², R J Jarrett³, E Breeze², M G Marmot², G Davey Smith³

¹ MRC Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
² Department of Epidemiology and Public Health, University College London, London, UK
³ Bishopsthorpe Road, London, UK
⁴ Department of Social Medicine, University of Bristol, Bristol, UK

Correspondence to:
Dr G David Batty
MRC Social & Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK; david-b{at}msoc.mrc.gla.ac.uk

Objective: To examine the relations between obesity or overweight and coronary heart disease (CHD) mortality in men with and without prevalent CHD in a prospective cohort study.

Methods: In the Whitehall study of London-based male government employees, 18 403 middle age men were followed up for a maximum of 35 years having participated in a medical examination in the late 1960s in which weight, height, CHD status, and a range of other social, physiological, and behavioural characteristics were measured.

Results: In age-adjusted analyses of men with baseline CHD there was a modest raised risk in the overweight relative to normal weight groups for all cause mortality (hazard ratio 1.10, 95% confidence interval (CI) 1.00 to 1.20) and CHD mortality (1.28, 95% CI 1.11 to 1.47) but not for stroke mortality (1.01, 95% CI 0.73 to 1.40). Mortality was similarly raised in the obese group. While these slopes were much steeper in men who were apparently CHD-free at study induction, the difference in the gradients according to baseline CHD status did not attain significance at conventional levels (p value for interaction 0.24). The weight–mortality relations were somewhat attenuated when potential mediating and confounding factors were added to the multivariable models in both men with and men without a history of CHD.

Conclusions: Avoidance of obesity and overweight in adult life in men with and without CHD may reduce their later risk of total and CHD mortality.

Abbreviations: BMI, body mass index; CHD, coronary heart disease; CI, confidence interval; FEV₁, forced expiratory volume in one second; ICD, International classification of diseases

Keywords: obesity; overweight; coronary heart disease; mortality; cohort study

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