Fat distribution and risk of coronary heart disease in men and women in the EPIC-Norfolk cohort: a population-based prospective study with 2,590 cases and 233,525 person-years of follow-up

Background: Fat distribution, particularly abdominal obesity, has been associatedwith a more adverse metabolic profile but its prospective relation with coronary heartdisease (CHD) is inconsistent. We examined the relation between fat distribution andincident CHD in the general population.Methods: At baseline, we examined men and women (N=25,623) recruited for theEPIC-Norfolk (UK) cohort study. We collected data on fat distribution, as indicatedby waist circumference (WC), hip circumference (HC) and waist-hip ratio (WHR),and total adiposity, as indicated by body mass index (BMI). Participants werefollowed up for incident fatal and non-fatal CHD as ascertained from deathcertificates and hospital admission records.Results: After 233,525 person-years of follow-up, there were 2,590 CHD events.CHD risk increased linearly across the whole range of WHR in both men and women,with or without adjustments for BMI, potential confound ers, and classical CHD riskfactors. Relative to those at the bottom WHR quintile, hazard ratio for the top WHRquintile was 1.47 [95% confidence interval (CI) 1.21 to 1.79] in men and 1.76 (95%CI 1.31 to 2.36) in women. Hazard ratios for BMI were weaker and attenuated whenadjusting for WHR or other covariates. When used in the same Cox???s regressionmodel, hazard ratio increased with WC but decreased with HC after adjusting for BMIand other covariates.Conclusion: Fat distribution was independently related to incident CHD among menand women. This prospective relation is consistent with the separate and oppositemetabolic associations of central and peripheral fat distribution observed crosssectionally.