Body weight and risk of myocardial infarction and death in the adult population of eastern Finland.

Abstract

Body mass index (weight (kg) divided by height squared (m2)) and its association with the risk of myocardial infarction and death from all causes were studied prospectively in a randomly selected population sample in eastern Finland aged 30-59 at outset in 1972. The study population consisted of 3786 men and 4120 women. The participation rate in the survey in 1972 was over 90%. AlU deaths and admissions to hospital in the sample were obtained from the National Death Certificate and Hospital Discharge Registers. During the seven years of follow up until 1978, 170 men and 52 women had acute myocardial infarction, and during the nine years up to 1980, 223 men and 92 women died. Independent of age, men with a body mass index of 28-5 or more had a significantly higher incidence of acute myocardial infarction. This effect was also independent of smoking but not independent of biological coronary risk factors-that is, serum cholesterol concentration and blood pressure. In the analysis stratified for smoking in men the body mass index total mortality curve was J shaped among non-smokers, whereas smoking entirely outweighed body mass index as a predictor of death. Body mass index did not contribute significantly to the risk of either acute myocardial infarction or death in women.It is concluded that a body mass index of around 29-0-31,0 or more is not only a marker for coronary risk factors but is also a predictor of acute myocardial infarction in men. IntroductionSeveral studies have examined whether obesity is associated with increased mortality or more frequent coronary heart disease. Though the risk of death for people who are very obese has turned out to be unequivocally higher than that for non-obese people,'3 results have been inconsistent.4 '4 The role of obesity seems to vary in importance-among different populations, at different ages, and between men and women. The detection of smoking as a powerful confounder of the relation between relative body weight and coronary heart disease and death has clarified part of this issue. 15-l' In the Framingham study, particularly in men under 50 and in women, obesity was found to be a predictor of the incidence of and mortality from coronary heart disease independent of age, serum lipoprotein values, blood pressure, smoking, and other risk factors," and in a recent report obesity was also related to mortality in non-smokers aged 65 and over.'" These findings have not been replicated in other parts of the world. After 15 years of follow up in the seven countries study Keys et al could not find an excess risk for death from all causes or coronary heart disease with increasing weight in any of the regions surveyed.'4 A study in Britain found a strong modifying effect of age on the association between weight and mortality (positive in 40-49 year olds, inverse in 60-64 year olds) and could not confirm overweight as an independent risk factor.9 In Finnish people aged 85 and over survival was positively associated with relative weight.20Not surprisingly the importance...

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