Obesity attenuates gender differences in cardiovascular mortality.
BACKGROUND
To estimate cardiovascular disease (CVD) mortality in relation to obesity and gender.


METHODS
Data from 11 prospective cohorts from four European countries including 23 629 men and 21 965 women, aged 24 to 99 years, with a median follow-up of 7.9 years were analyzed. Hazards ratios (HR) for CVD mortality in relation to baseline body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were estimated using Cox proportional hazards models with age as the timescale.


RESULTS
Men had higher CVD mortality than women in all four BMI categories (<25.0, 25.0-29.9, 30.0-34.9 and ≥35.0 kg/m(2)). Compared with the lowest BMI category in women, multivariable adjusted HRs (95% confidence intervals) for higher BMI categories are 1.0 (0.8-1.4), 1.6 (1.1-2.1) and 2.8 (2.0-3.8) in women and 2.8 (2.2-3.6), 3.1 (2.5-3.9), 3.8 (2.9-4.9) and 5.4 (3.8-7.7) in men, respectively. Similar findings were observed for abdominal obesity defined by WC, WHR or WHtR. The gender difference was slightly smaller in obese than in non-obese individuals; but the interaction was statistically significant only between gender and WC (p = 0.02), and WHtR (p = 0.01). None of the interaction terms was significant among non-diabetic individuals.


CONCLUSIONS
Men had higher CVD mortality than women across categories of anthropometric measures of obesity. The gender difference was attenuated in obese individuals, which warrants further investigation.
Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland. xin.song@helsinki.fi.|Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. xin.song@helsinki.fi.
Xin
X
Song
Department of Epidemiology and Public Health, University College London, London, UK. a.tabak@ucl.ac.uk.|1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary. a.tabak@ucl.ac.uk.
Adam G
AG
Tabák
Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden. bjorn.zethelius@pubcare.uu.se.|Medical Products Agency, Uppsala, Sweden. bjorn.zethelius@pubcare.uu.se.
Björn
B
Zethelius
Department of Medicine, University College London, London, UK. j.yudkin@ucl.ac.uk.
John S
JS
Yudkin
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. stefan.soderberg@medicin.umu.se.|Baker IDI Heart and Diabetes Institute, Melbourne, Australia. stefan.soderberg@medicin.umu.se.
Stefan
S
Söderberg
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. tiina.laatikainen@thl.fi.|Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland. tiina.laatikainen@thl.fi.|Hospital District of North Karelia, Joensuu, Finland. tiina.laatikainen@thl.fi.
Tiina
T
Laatikainen
Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands. cda.stehouwer@mumc.nl.
Coen D A
CD
Stehouwer
Unit for Cardiovascular Epidemiology, The Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel. RachelD@gertner.health.gov.il.|Division of Epidemiology and Prevention, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. RachelD@gertner.health.gov.il.
Rachel
R
Dankner
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. pekka.jousilahti@thl.fi.
Pekka
P
Jousilahti
Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul, Turkey. alt_onat@yahoo.com.tr.
Altan
A
Onat
Department of Clinical Sciences, Lund University, Malmö, Sweden. peter.nilsson@med.lu.se.|Center of Emergency Medicine, Skåne University Hospital, Malmö, Sweden. peter.nilsson@med.lu.se.
Peter M
PM
Nilsson
Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey. satmandiabet@gmail.com.
Ilhan
I
Satman
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. ovaccaro@unina.it.
Olga
O
Vaccaro
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. jaakko.tuomilehto@thl.fi.|Center for Vascular Prevention, Danube University Krems, Krems, Austria. jaakko.tuomilehto@thl.fi.|King Abdulaziz University, Jeddah, Saudi Arabia. jaakko.tuomilehto@thl.fi.|Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain. jaakko.tuomilehto@thl.fi.
Jaakko
J
Tuomilehto
Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland. qing.qiao@helsinki.fi.|Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. qing.qiao@helsinki.fi.|R&D AstraZeneca AB, Mölndal, Sweden. qing.qiao@helsinki.fi.
Qing
Q
Qiao
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D055105:Waist Circumference / Q000502:physiology*; D049629:Waist-Hip Ratio