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Body Fat Distribution and Risk of Coronary Heart Disease in Men and Women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk Cohort: A Population-Based Prospective Study
Abstract
Background— Body fat distribution has been cross-sectionally associated with atherosclerotic disease risk factors, but the prospective relation with coronary heart disease remains uncertain. Methods and Results— We examined the prospective relation between fat distribution indices and coronary heart disease among 24 508 men and women 45 to 79 years of age using proportional hazards regression. During a mean 9.1 years of follow-up, 1708 men and 892 women developed coronary heart disease. The risk for developing subsequent coronary heart disease increased continuously across the range of waist-hip ratio. Hazard ratios (95% CI) of the top versus bottom fifth of waist-hip ratio were 1.55 (1.28 to 1.73) in men and 1.91 (1.44 to 2.54) in women after adjustment for body mass index and other coronary heart disease risk factors. Hazard ratios increased with waist circumference, but risk estimates for waist circumference without hip circumference adjustment were lower by 10% to 18%. After adjustment for waist circumference, body mass index, and coronary heart disease risk factors, hazard ratios for 1-SD increase in hip circumference were 0.80 (95% CI, 0.74 to 0.87) in men and 0.80 (95% CI, 0.69 to 0.93) in women. Hazard ratios for body mass index were greatly attenuated when we adjusted for waist-hip ratio or waist circumference and other covariates. Conclusions— Indices of abdominal obesity were more consistently and strongly predictive of coronary heart disease than body mass index. These simple and inexpensive measurements could be used to assess obesity-related coronary heart disease risk in relatively healthy men and women.
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“Literature shows that individuals with a healthy weight, but high visceral fat, are at higher cardiovascular risk than those with a higher BMI (Canoy et al., 2007; Stefan & Schulze, 2023).”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Canoy et al., 2007
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BackgroundMicroRNA‐196 Regulates HOX Gene Expression in Human Gluteal Adipose Tissue
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“Additionally, estrogen, produced by fat cells42, has been shown to be protective against CVD in women43.”
BackgroundInfluential
Metadata
- Authors
- Canoy, D., Boekholdt, S. M., Wareham, N., Luben, R., Welch, A., Bingham, S., Buchan, I., Day, N., & Khaw, K.-T.
- Affiliations
- University of Cambridge (GB)
- ORCID
- Venue
- Circulation
- Published
- 2007-12-18
- Volume
- 116
- Issue
- 25
- Pages
- 2933-2943
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1995930672
- Cited by
- 472
- References
- 59
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 17 · 2023: 11 · 2022: 19 · 2021: 30 · 2020: 10 · 2019: 18 · 2018: 22 · 2017: 24 · 2016: 13 · 2015: 27 · 2014: 39 · 2013: 50 · 2012: 37
- FWCI
- 22.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- body fat distribution, coronary artery disease, waist-to-hip ratio, waist circumference, hip circumference, abdominal obesity, body mass index, cardiovascular risk, sex differences, EPIC-Norfolk cohort
- MeSH terms
- Aged, Coronary Disease, Female, Follow-Up Studies, United Kingdom, Humans, Male, Middle Aged, Myocardial Infarction, Obesity, Predictive Value of Tests, Prospective Studies, Risk Factors, Cohort Studies, Proportional Hazards Models, Sex Distribution, Waist-Hip Ratio, Body Fat Distribution
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