OBJECTIVE:To assess to what extent the incidence of coronary events and death related to smoking, hypertension, hyperlipidemia and diabetes is modified by obesity. DESIGN: Prospective cohort study. SUBJECTS: A total of 22 025 men aged 27 to 61-y-old at entry. MEASUREMENTS: Incidence of coronary events (CE, ie acute myocardial infarctions and deaths due to chronic ischaemic heart disease) and death during 23 y of follow-up was studied in relation to body mass index (BMI), heart rate, blood pressure, blood lipids, glucose and insulin, lifestyle factors, history of angina pectoris, history of cancer, self-reported health and socio-economic conditions. RESULTS: At the end of follow-up 20% of the obese men were no longer alive, and 13% had had a coronary event. Incidence of CE was 16% lower (RR (relative risk) 0.84; 95% confidence interval (CI) 0.65 -1.10) among underweight (n ¼ 1171), 24% higher (RR 1.24; CI 1.12 -1.37) among overweight (n ¼ 7773), and 76% higher (RR 1.76; 95% CI 1.49 -2.08) among obese men (n ¼ 1343) than it was among men with normal BMI (n ¼ 11 738). The risk associated with overweight and obesity remained statistically significant after adjustment for potential confounders (RR 1.18; CI 1.07 -1.31; and 1.39; 1.17 -1.65, respectively). The association between BMI and mortality was J-shaped. In all, 1.7% of the obese men were smokers with hypertension, hyperlipidaemia and diabetes, 16.3% were not exposed to any of these risk factors. The cardiovascular risk associated with obesity was small in the absence of other risk factors. Between smoking and obesity there was a statistically significant synergistic effect. CONCLUSIONS: Obesity is associated with an increased incidence of coronary events and death. The risk associated with obesity is substantially increased by exposure to other atherosclerotic risk factors, of which smoking seems to be the most important. The preventive potential of these associations should be evaluated in controlled trials.

Background-Although obesity is associated with increased inflammation, it is unclear whether this accounts for the increased cardiovascular risk in obesity. This population-based study explored whether inflammation-sensitive plasma proteins (ISPs) modify the cardiovascular risk in overweight or obese men. Methods and Results-The ISPs (fibrinogen, orosomucoid, ␣1-antitrypsin, haptoglobin, ceruloplasmin) were measured in 6075 healthy men, aged 28 to 61 years. The incidences of cardiovascular events (myocardial infarction, stroke, cardiovascular deaths), cardiac events (fatal or nonfatal myocardial infarction), and stroke were followed-up over 18Ϯ4 years. High ISPs were associated with an increased cardiovascular risk in all categories of body mass index (BMI). The age-adjusted relative risks for cardiovascular events in obese men (BMI Ͼ30) were 2.1 (95% CI, 1.4 to 3.4), 2.4 (CI, 1.5 to 3.7), 3.7 (CI, 2.3 to 6.0), and 4.5 (CI, 3.0 to 6.6), respectively, for those with 0, 1, 2, and Ն3 ISPs in the top quartile (trend Pϭ0.002) (reference: BMI Ͻ25 and no elevated ISP). This trend persisted after adjustments for several potential confounders (Pϭ0.02). Incidence of cardiac events showed similar relations with the number of elevated ISPs in obese men. Conclusion-The cardiovascular risk varies widely between obese or overweight men with high and low ISPs.Relationships with ISPs contribute to, but cannot fully explain, the increased cardiovascular risk in obese men.

Background. People, who are single, have a bluecollar job or low income have an increased cardiovascular risk. This study on myocardial infarction sought to explore whether the socio-economic pattern of disease has any relationship with obesity. Methods. In the cohort are 20 099 middle-aged men of whom 9150 were manual and 9190 nonmanual workers and 1759 were self-employed. A total of 4081 were single, 16 018 cohabiting. The body mass index (BMI) cut-off values for overweight and obesity were 25-30 and ‡30 kg m )2 , respect-