Severe obesity, heart disease, and death among white, African American, and Hispanic postmenopausal women.
OBJECTIVE
To compare mortality, nonfatal coronary heart disease (CHD), and congestive heart failure (CHF) risk across BMI categories in white, African American, and Hispanic women, with a focus on severe obesity (BMI ≥ 40), and examine heterogeneity in weight-related CHD risk.


METHODS
Among 156,775 Women's Health Initiative observational study and clinical trial participants (September 1993-12 September 2005), multivariable Cox models estimated relative risk for mortality, CHD, and CHF. CHD incidence was calculated by anthropometry, race, and cardiovascular risk factors (CVRF).


RESULTS
Mortality, nonfatal CHD, and CHF incidence generally rose with BMI category. For severe obesity versus normal BMI, hazard ratios (HRs, 95% confidence interval) for mortality were 1.97 (1.77-2.20) in white, 1.55 (1.20-2.00) in African American, and 2.59 (1.55-4.31) in Hispanic women; for CHD, HRs were 2.05 (1.80-2.35), 2.24 (1.57-3.19), and 2.95 (1.60-5.41) respectively; for CHF, HRs were 5.01 (4.33-5.80), 3.60 (2.30-5.62), and 6.05 (2.49-14.69). CVRF variation resulted in substantial variation in CHD rates across BMI categories, even in severe obesity. CHD incidence was similar by race/ethnicity when differences in BMI or CVRF were accounted for.


CONCLUSIONS
Severe obesity increases mortality, nonfatal CHD, and CHF risk in women of diverse race/ethnicity. CVRF heterogeneity contributes to variation in CHD incidence even in severe obesity.
University of Pittsburgh Departments of Medicine & Public Health, Pittsburgh, Pennsylvania, USA.
Kathleen M
KM
McTigue
Yue-Fang
YF
Chang
Charles
C
Eaton
Lorena
L
Garcia
Karen C
KC
Johnson
Cora E
CE
Lewis
Simin
S
Liu
Rachel H
RH
Mackey
Jennifer
J
Robinson
Milagros C
MC
Rosal
Linda
L
Snetselaar
Alice
A
Valoski
Lewis H
LH
Kuller
D001741:Black or African American; D000368:Aged; D015992:Body Mass Index; D002136:Calcium, Dietary / Q000008:administration & dosage; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology*; D006630:Hispanic or Latino; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology*; D017698:Postmenopause; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage; D044465:White People
D002136:Calcium, Dietary; D006728:Hormones; D014807:Vitamin D
cardiovascular diseases/epidemiology; cardiovascular diseases/etiology; longitudinal studies; obesity, morbid/complications; obesity, morbid/epidemiology; obesity/epidemiology, obesity/complications