title: Smoking habits, waist circumference and coronary artery disease risk relationship: the PRIME study.
abstract: BACKGROUND
  Abdominal obesity is an important risk factor for coronary artery disease (CAD). The extent to which tobacco exposure influences the effect of abdominal adiposity on CAD incidence remains uncertain. Therefore, the goal of this study was to assess the effects of tobacco exposure on CAD risk associated with abdominal obesity.
  
  
  METHODS
  A cohort of 9763 men, aged 50-59 years, without known CAD was followed 10 years for CAD events. Risk factors were recorded using a questionnaire, a clinical examination, including waist circumference (WC) and waist-to-hip ratio (WHR) and biological measurements. Cox regression was used for statistical analyses.
  
  
  RESULTS
  During follow-up, there were 659 incident CAD events. BMI, WC, WHR, blood pressure, cholesterol, high-density lipid cholesterol and triglycerides, physical activity and alcohol intake varied across smoking exposure categories. The incidence of CAD increased across tertiles of waist circumference in never (5.1, 6.1 and 7.2 CAD events/1000 in first, second and third tertiles of WC distribution, respectively), former (6.6, 7.8 and 9.3 events/1000, across tertiles) and current smokers (9.4, 11 and 13.1 events/1000, across tertiles). After adjusting for age, centre, educational level, alcohol intake and physical activity, the relative risk of CAD was 1.28 (1.08-1.51) for 1 standard deviation increase of WC in never smokers, 1.23 (1.08-1.38) in former smokers and 1.14 (1.00-1.29) in current smokers. Similar results were observed for WHR. No evidence for heterogeneity among tobacco exposure strata for both WC and WHR was observed.
  
  
  CONCLUSIONS
  In conclusion, the relative risk of CAD associated with abdominal obesity is homogeneous in never, former and current smokers. Therefore, smokers with abdominal obesity are at high absolute risk of CAD.
authors.affiliation: INSERM, U744, Pasteur Institute of Lille, Lille 2 University, Lille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chouraki
authors.forename: Aline
authors.initials: A
authors.lastname: Wagner
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.forename: Annie
authors.initials: A
authors.lastname: Bingham
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haas
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.forename: Alun
authors.initials: A
authors.lastname: Evans
authors.forename: Pierre
authors.initials: P
authors.lastname: Ducimetière
authors.forename: Philippe
authors.initials: P
authors.lastname: Amouyel
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D013997:Time Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio