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

Aims 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). Methods and 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. Conclusion 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. (C) 2004 Published by Elsevier Ltd on behalf of The European Society of Cardiology.