title: Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women.
abstract: OBJECTIVE
  To assess joint associations of physical activity and different indicators of obesity (body mass index, waist circumference, and waist-to-hip ratio) with the risk of cardiovascular disease (CVD).
  
  
  RESULTS
  The study comprised 18,892 Finnish men and women aged 25-74 years without history of coronary heart disease, stroke, or heart failure at baseline. Physical activity, different indicators of obesity, education, smoking, blood pressure, total and high-density lipoprotein cholesterol and history of diabetes were measured at baseline. An incident CVD event was defined as the first stroke or coronary heart disease event or CVD death based on national hospital discharge and mortality register data. The median follow-up time was 9.8 years. Physical activity had a strong, independent, and inverse association with CVD risk in both genders. All obesity indicators had a significant direct association with CVD risk after adjustment for age, smoking, education and physical activity. Further adjustment for the obesity-related risk factors weakened the associations and they remained statistically significant in men only. Physical activity and the obesity indicators both predicted CVD risk in men, but in women the joint effect was inconsistent.
  
  
  CONCLUSIONS
  Both regular physical activity and normal weight can reduce the risk of CVD. Physical inactivity seems to have an independent effect on CVD risk, whereas obesity increases the risk partly through the modification of other risk factors.
authors.affiliation: Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. hu.gang@ktl.fi
authors.forename: Gang
authors.initials: G
authors.lastname: Hu
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: Karri
authors.initials: K
authors.lastname: Silventoinen
authors.forename: Nöel
authors.initials: N
authors.lastname: Barengo
authors.forename: Pekka
authors.initials: P
authors.lastname: Jousilahti
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015444:Exercise / Q000502:physiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D049629:Waist-Hip Ratio