Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: study conducted in 20,000 Dutch men and women aged 20-65 years

Eur J Cardiovasc Prev Rehabil. 2009 Dec;16(6):729-34. doi: 10.1097/HJR.0b013e328331dfc0.


Aims: Body mass index (BMI) and waist circumference (WC) are both predictors of cardiovascular diseases (CVD). We compared absolute risk, hazard ratio (HR), and population attributable risk of nonfatal and fatal CVD for BMI and WC in a large prospective cohort study with an average follow-up of 10 years.

Methods and results: Anthropometric data were measured between 1993 and 1997 in a general population sample of over 20,000 men and women aged 20-65 years in the Netherlands. All risks were adjusted for age and sex. Absolute risk of nonfatal CVD was on average 10 times higher than that of fatal CVD. In obese respondents (BMI >or=30 kg/m2), relative risk of fatal CVD was four-fold higher [HR=4.0 95% confidence interval (CI)=2.4-6.6], whereas risk of nonfatal CVD was two-fold higher (HR=1.8 95% CI=1.6-2.2) than in normal-weight respondents. Similar associations were observed for WC (>or=88 vs. <80 cm in women and >or=102 vs. 94 cm in men). In persons with overweight or obesity (BMI >or=25 kg/m2), half of all fatal CVD (attributable risk=54%, 95% CI=30-70) and a quarter of nonfatal CVD was ascribed to their overweight. On the population level, one-third of all fatal CVD cases could be attributed to overweight and obesity (population attributable risk=35%, 95% CI=14-52), and about one in seven of nonfatal CVD cases.

Conclusion: The associations of BMI and WC with CVD risk were equally strong. Overweight and obesity had a stronger impact on fatal CVD than on nonfatal CVD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Body Mass Index*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Female
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Obesity / complications
  • Obesity / epidemiology*
  • Obesity / mortality
  • Overweight / complications
  • Overweight / epidemiology*
  • Overweight / mortality
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Waist Circumference*
  • Young Adult