title: A prospective study of obesity and risk of coronary heart disease among diabetic women.
abstract: OBJECTIVE
  To examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes.
  
  
  METHODS
  We followed 5,897 women with type 2 diabetes in the Nurses' Health Study for < or = 20 years. Women were aged 40-74 years and had no history of cardiovascular disease or cancer at the beginning of the follow-up period. BMI values from three time points (age 18 years, year 1976, and current) were derived from the reported height (1976) and corresponding reported weight. Weight changes between age 18 years and 1976 and after diagnosis of diabetes were calculated. Women reported diagnoses of diabetes and CHD every 2 years. Incident CHD cases were confirmed by medical record review.
  
  
  RESULTS
  During follow-up, we documented 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI was strongly associated with increased risk of CHD among diabetic women. The multivariate relative risks across increasing categories of BMI (<23.0, 23.0-24.9, 25.0-26.9, 27.0-29.9, 30.0-34.9, and > or = 35.0 kg/m(2)) were 1.0, 1.58, 1.85, 1.95, 2.80, and 3.21, respectively (P for trend <0.001). Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes was not associated with risk of CHD.
  
  
  CONCLUSIONS
  These findings provide strong evidence that obesity and weight gain before diagnosis of diabetes are associated with future risk of CHD among women with type 2 diabetes.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. eunyoung.cho@channing.harvard.edu
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Cho
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Meir J
authors.initials: MJ
authors.lastname: Stampfer
authors.forename: Caren G
authors.initials: CG
authors.lastname: Solomon
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Frank E
authors.initials: FE
authors.lastname: Speizer
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D003327:Coronary Disease / Q000453:epidemiology*; D048909:Diabetes Complications; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009726:Nurses; D009765:Obesity; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D015430:Weight Gain