title: Impact of abdominal obesity and systemic hypertension on risk of coronary heart disease in men and women: the EPIC-Norfolk Population Study.
abstract: BACKGROUND
  The objective of our study was to determine the respective contributions of waist circumference and systemic hypertension (HTN) to coronary heart disease (CHD) risk in a large population-based cohort representative of a contemporary European population.
  
  
  RESULTS
  A total of 9580 men and 12 250 women aged 45-79 years were followed for 11.4 years. Over the follow-up, 2191 CHD events were recorded. After adjusting for traditional CHD risk factors, individuals with high blood pressure (BP) and high waist circumference were at an increased CHD risk [hazard ratio 3.04; 95% confidence interval (CI) 2.06-4.48 and 2.90 (1.85-4.55) in men and women, respectively], compared with individuals with both low waist circumference and BP. Among individuals with normal BP, those in the top waist circumference tertile were at an increased CHD risk compared with those in the bottom waist circumference tertile (hazard ratio 2.66; 95% CI 1.59-4.45 and 2.11; 95% CI 1.12-3.97 in men and women, respectively). Within each physical activity category, a linear positive association was observed between waist circumference tertiles and both SBP (P for trend <0.001) and DBP (P for trend <0.001). Within each waist circumference tertile, inactive individuals had higher SBP than active individuals (P for trend <0.001).
  
  
  CONCLUSIONS
  Our results show that abdominal obesity (measured by waist circumference) and HTN had both independent and additive contributions to CHD risk. We also found that physical inactivity and abdominal obesity contribute to elevated BP in primary prevention settings.
authors.affiliation: aCentre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City bDepartment of Family Medicine and Emergency Medicine cDepartment of Medicine dDepartment of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada eDepartment of Cardiology, Academic Medical Center, Amsterdam, the Netherlands fMedical Research Council Epidemiology Unit gDepartment of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rhéaume
authors.forename: Benoit J
authors.initials: BJ
authors.lastname: Arsenault
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Després
authors.lastname: Faha
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Mbb
authors.initials: M
authors.lastname: Chir
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D055105:Waist Circumference