The American Journal of Cardiology
Volume 100, Issue 11, 1 December 2007, Pages 1654-1658

Comparison of Usefulness of Body Mass Index Versus Metabolic Risk
Factors in Predicting 10-Year Risk of Cardiovascular Events in Women

Yiqing Song MD, ScDa, , , JoAnn E. Manson MD, DrPHa, b, James B. Meigs
MDc, Paul M. Ridker MDa, d, Julie E. Buring ScDa, b, e and Simin Liu
MD, ScDa, b, f, g
aDepartment of Medicine, Division of Preventive Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, Massachusetts
bDepartment of Epidemiology, Harvard School of Public Health, Boston,
Massachusetts
cGeneral Medicine Division, Massachusetts General Hospital, Harvard
Medical School, Boston, Massachusetts
dCenter for Cardiovascular Disease Prevention and the Donald Reynolds
Center for Cardiovascular Research, Division of Cardiovascular
Diseases, Brigham and Women's Hospital, Harvard Medical School,
Boston, Massachusetts
eDepartment of Ambulatory Care and Prevention, Harvard Medical School,
Boston, Massachusetts
fDepartment of Epidemiology, UCLA School of Public Health, Los
Angeles, California
gDepartment of Medicine, David Geffen School of Medicine, UCLA, Los
Angeles, California.

The objective of this study was to prospectively examine the
comparative importance of body mass index (BMI) and metabolic syndrome
(MS) related risk factors in predicting future risk of cardiovascular
disease (CVD) in women. Of 25,626 women aged ≥45 years and free of
CVD, cancer, and diabetes at baseline in the Women's Health Study, all
women were classified into 6 groups according to 3 BMI categories
(<25, 25 to 29.9, and ≥30 kg/m2) and the presence or absence of MS,
defined using modified criteria of the National Cholesterol Education
Program Adult Treatment Program III. During a median 10-year follow-
up, 724 incident CVD events were documented. Compared with lean women
without MS, multivariate relative risks of CVD, adjusting for age,
physical activity, and other covariates, were 2.40 (95% confidence
interval [CI] 1.71 to 3.37) for lean women who had MS, 1.08 (95% CI
0.87 to 1.33) for overweight women who had no MS, 3.01 (95% CI 2.30 to
3.94) for overweight women with MS, 1.58 (95% CI 1.21 to 2.08) for
obese women without MS, and 2.89 (95% CI 2.19 to 3.80) for obese women
with MS. Similar associations were evident for total coronary heart
disease, but were not significant for total stroke. Overall, although
C-reactive protein added additional prognostic information beyond BMI
and MS, it did not fully account for the observed high risk of CVD
associated with MS. In conclusion, MS may largely account for the
increased risk of CVD associated with BMI in apparently healthy
women.

This study was supported by Grants DK66401, CA-47988, HL-43851, and
HL-65727 from the National Institutes of Health, Bethesda, Maryland.
Dr. Meigs is supported by an American Diabetes Association Career
Development Award, Alexandria, Virginia.
Corresponding author: Tel: 617-278-0913; Fax: 617-731-3843.