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Scandinavian Journal of Public Health, Vol. 35, No. 1, 4-10 (2007)
DOI: 10.1080/14034940510032293
© 2007 Associations of Public Health in the Nordic Countries Regions

Predictiveness of body mass index for fatal coronary heart disease in men according to length of follow-up: A 21-year prospective cohort study

Lise Lund Håheim

Norwegian Health Service Research Centre, UllevÅl University Hospital, Oslo, Norway, lise.lund.haheim{at}nhsrc.no

Serena Tonstad

Department of Preventive Cardiology, Preventive Medicine Clinic, UllevÅl University Hospital, Oslo, Norway

Ingvar Hjermann

Department of Preventive Cardiology, Preventive Medicine Clinic, UllevÅl University Hospital, Oslo, Norway

Paul Leren

Department of Preventive Cardiology, Preventive Medicine Clinic, UllevÅl University Hospital, Oslo, Norway

Ingar Holme

Department of Preventive Cardiology, Preventive Medicine Clinic, UllevÅl University Hospital, Oslo, Norway

Aims: To test the association between body mass index (BMI) and other coronary risk factors and the risk of a fatal coronary heart disease (CHD) event in different time periods during follow-up. Methods: Prospective cohort study with a 21 year follow-up period. A screened sample of 14,403 men aged 40—49 years initially free of CHD. Risk of fatal CHD was calculated for 21 years' cumulative follow-up and for four consecutive 5-year periods. Results: After adjustment for age and the other risk factors, total cholesterol and systolic blood pressure retained their predictive strength for CHD mortality throughout follow-up. Though cigarette smoking remained a significant predictor, the relative risk decreased with time (test of trend: p=0.01). Intermediate to vigorous physical activity at leisure was protective for 10 years of follow-up and a question on mental stress for 5 years. The test of trend indicated that the risk associated with BMI increased with the duration of follow-up (p=0.002). Conclusions: Our data show that coronary risk factors predicted CHD mortality differently according to the length of follow-up, and suggest that the harm associated with obesity may take more than a decade to become evident, in contrast to the classical CHD risk factors.

Key Words: Body mass index • coronary heart disease • mortality • prospective cohort • risk factors


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