Obesity, Not Cholesterol, Causes Heart Attacks

OBJECTIVE: To evaluate the contributions of socioeconomic, lifestyle, and body weight factors to predicted heart disease (CHD) in the population and thus provide a focus for policies on prevention.

DESIGN: Prospective study and cross-sectional population health survey.

SUBJECTS: In all, 3090 men in the Framingham study and 2571 men in the 1998 Health Survey for England (HSE) with no history of cardiovascular disease participated in the study.

MEASUREMENTS: Data on sex, age, systolic blood pressure and antihypertensive medication, total and high-density cholesterol levels, diabetes, and their association with the incidence of myocardial infarction and fatal CHD in study population were used to derive functions for predicting individual 10-y risk of CHD. These functions were same data on participants in the HSE. High risk was defined as 10-y CHD risk >/=15%. The proportion of high risk population attributable to each of the risk factors examined was assessed.

RESULTS: In all, 32% of men in England had predicted 10-y CHD risk >/=15%. Such high risk was significantly body mass index (BMI, kg/m2), waist:hip ratio (WHR), smoking, and levels of physical activity, educational income (all </=0.007). In this population, 47% of high CHD risk was attributable to excess body weight – BMI >/=25 or WHR >/=0.95 – and 31% to the sum of the four other significant factors: lack of educational qualifications, smoking, and physical inactivity.

CONCLUSION: Overweight and obesity now dominate the standard risk factors of CHD in men and should national policies for prevention.