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

George David Batty ^1*, Martin Shipley ², John Jarrett ³, Elizabeth Breeze ², Michael Marmot ² and George Davey Smith ⁴

¹ University of Glasgow, United Kingdom
² University College London, United Kingdom
³ Bishopsthorpe Road, United Kingdom
⁴ University of Bristol, United Kingdom

^* To whom correspondence should be addressed. E-mail: david-b{at}msoc.mrc.gla.ac.uk.

Accepted 20 October 2005

Abstract

Background: The few reports of the association of obesity and/or overweight with total and cardiovascular disease mortality in persons with existing coronary heart disease (CHD) reveal inconsistent findings. We sought to examine these relationships in both 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 elevated risk in the overweight relative to normal weight groups for all- cause mortality (hazards ratio [95% CI]: 1.10 [1.00, 1.20]) and coronary heart disease mortality (1.28 [1.11, 1.47]), but not for stroke mortality (1.01 [0.73, 1.40]). Mortality rates were similarly raised in the obese group. While these slopes were markedly steeper in men who were apparently CHD-free at study induction, the difference in the gradients according to baseline CHD status did not attain statistical significance at conventional levels (p-value for interaction: 0.24). There was some attenuation of the weight- mortality relationships when potential mediating and confounding factors were added to the multivariable models in both men with and without a prior history of CHD.

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

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

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