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Original article
Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study
  1. Selcuk Adabag1,2,
  2. Rachel R Huxley1,3,
  3. Faye L Lopez1,
  4. Lin Y Chen4,
  5. Nona Sotoodehnia5,6,
  6. David Siscovick5,7,
  7. Rajat Deo8,
  8. Suma Konety4,
  9. Alvaro Alonso1,
  10. Aaron R Folsom1
  1. 1Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota, USA
  3. 3School of Population Health, University of Queensland, Brisbane, Queensland, Australia
  4. 4Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
  5. 5Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
  6. 6Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
  7. 7Department of Epidemiology, University of Washington, Seattle, Washington, USA
  8. 8Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Selcuk Adabag, Division of Cardiology (111 C), Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA; adaba001{at}


Objective To examine the association of body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) with sudden cardiac death (SCD) in community dwelling individuals.

Methods Data from a multicentre, prospective, cohort study of 14 941 men and women (African American, and white), aged 45–64 years, participating in the Atherosclerosis Risk in Communities study was analysed. Obesity measures were assessed at baseline (1987–1989). SCD was adjudicated by a committee.

Results At enrolment mean±SD age of the participants was 54±6 years (55% female; 26% African American). During 12.6±2.5 years of follow-up, 253 SCD occurred (incidence rate 1.34/100 person-years). The association between obesity and SCD differed by smoking status (interaction p≤0.01). In models adjusting for age, sex, race, study centre and education level, SCD risk was positively associated (p<0.001) with BMI, WC and WHR in non-smokers, but not in smokers. WHR was more strongly associated with SCD in non-smokers than was BMI or WC (HR per SD increment (95% CI) 2.00 (1.65 to 2.42); 1.34 (1.15 to 1.56) and 1.49 (1.28 to 1.74), respectively). After adjustment for potential mediators (hypertension, diabetes, lipid profile, prevalent coronary heart disease, heart failure, and LV hypertrophy), non-smokers in the highest WHR category (>0.95 in women; >1.01 in men) had double the risk of SCD (HR 2.03, 95% CI 1.19 to 3.46; incidence rate 1.43/1000 person-years) versus those with normal WHR.

Conclusions General obesity is associated with increased risk of SCD in middle-aged, non-smoking individuals, mediated by traditional cardiovascular risk factors. Central obesity, however, is independently associated with SCD by pathways that remain to be elucidated.

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