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.
- BMI, body mass index
- CHD, coronary heart disease
- CI, confidence interval
- FEV1, forced expiratory volume in one second
- ICD, International classification of diseases
- coronary heart disease
- cohort study
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Published Online First 3 November 2005
Funding: The original screening of participants in the Whitehall study was funded by the Department of Health and Social Security and the Tobacco Research Council. Martin Shipley is supported by the British Heart Foundation; Elizabeth Breeze by the US National Institutes of Health and a consortium of UK Government Departments; and Michael Marmot by the UK Medical Research Council. David Batty is a Wellcome Fellow. These funding agencies had or have no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.
Contributors: David Batty generated the idea for this paper and wrote the first draft on which all authors commented. Elizabeth Breeze and Martin Shipley updated the mortality data. Martin Shipley conducted all data analyses, had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.