doi: 10.1161/01.CIR.0000115514.44135.A8
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(Circulation. 2004;109:706-713.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Clinical Importance of Obesity Versus the Metabolic Syndrome in Cardiovascular Risk in Women
A Report From the Women’s Ischemia Syndrome Evaluation (WISE) Study
From the Department of Epidemiology (K.E.K., B.D.J., S.F.K.), University of Pittsburgh, Pittsburgh, Pa; University of Pittsburgh Medical Center (O.C.M., S.E.R.), Cardiovascular Institute, Pittsburgh, Pa; University of Pittsburgh School of Medicine (D.E.K.), Department of Medicine, Pittsburgh, Pa; Atlanta Cardiovascular Research Institute (L.J.S.), Atlanta, Ga; and University of Alabama at Birmingham (W.J.R.), Department of Medicine, Birmingham, Ala.
Correspondence to Kevin E. Kip, PhD, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto St, 127 Parran Hall, Pittsburgh, PA 15261. E-mail kipk{at}edc.pitt.edu
Received December 17, 2003; accepted December 17, 2003.
Background— Obesity and the metabolic syndrome frequently coexist. Both are associated with cardiovascular disease (CVD). However, the contribution of obesity to cardiovascular risk, independent of the presence of the metabolic syndrome, remains controversial.
Methods and Results— From the WISE study, 780 women referred for coronary angiography to evaluate suspected myocardial ischemia were classified by body mass index (BMI; <24.9=normal, n=184; 
25.0 to 
29.9=overweight, n=269; 30.0=obese, n=327) and presence (n=451) or absence (n=329) of the metabolic syndrome, further classified by diabetes status. Prevalence of significant angiographic coronary artery disease (CAD; 50% stenosis) and 3-year risk of CVD were compared by BMI and metabolic status. The metabolic syndrome and BMI were strongly associated, but only metabolic syndrome was associated with significant CAD. Similarly, unit increases in BMI (normal to overweight to obese) were not associated with 3-year risk of death (adjusted hazard ratio [HR] 0.92, 95% CI 0.59 to 1.51) or major adverse cardiovascular event (MACE: death, nonfatal myocardial infarction, stroke, congestive heart failure; adjusted HR 0.95, 95% CI 0.71 to 1.27), whereas metabolic status (normal to metabolic syndrome to diabetes) conferred an approximate 2-fold adjusted risk of death (HR 2.01, 95% CI 1.26 to 3.20) and MACE (HR 1.88, 95% CI 1.38 to 2.57). Levels of C-reactive protein (hs-CRP) were more strongly associated with metabolic syndrome than BMI but were not independently associated with 3-year risk of death or MACE.
Conclusions— The metabolic syndrome but not BMI predicts future cardiovascular risk in women. Although it remains prudent to recommend weight loss in overweight and obese women, control of all modifiable risk factors in both normal and overweight persons to prevent transition to the metabolic syndrome should be considered the ultimate goal.
Key Words: cardiovascular diseases • follow-up studies • inflammation • obesity • women
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