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Michael E. Widlansky, MD; Howard D. Sesso, ScD, MPH; Kathryn M. Rexrode, MD, MPH; JoAnn E. Manson, MD, DrPH; J. Michael Gaziano, MD, MPH

Arch Intern Med. 2004;164:2326-2332.

Background  Previous studies designed to identify an association between body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and cardiovascular or total mortality in populations with known atherosclerotic disease have shown conflicting results. In this study, we used the Physicians’ Health Study enrollment cohort to examine the risk of total and cardiovascular mortality among men reporting a history of myocardial infarction or stroke, excluding those who reported a history of cancer.

Methods  Cause-specific death was ascertained for 5010 men during a mean follow-up of 5.0 years. End points were classified as total deaths and deaths due to cardiovascular causes. Four BMI categories (<22.0, 22.0-24.9 [referent], 25.0-27.9, and 28.0) were created a priori. We used proportional hazards models to calculate age and multivariate-adjusted relative risks (RRs) for each BMI category for each end point.

Results  Compared with men with a BMI of 22.0 to 24.9, men with a BMI of 28.0 or greater had an age-adjusted RR of 1.11 (95% confidence interval [CI], 0.91-1.36), a multivariate RR of 1.04 (95% CI, 0.84-1.28) in a model that did not include biological mediators of obesity, and a multivariate RR of 1.06 (95% CI, 0.78-1.44) in a model that included these mediators. The RRs for cardiovascular mortality were similar, at 1.07 (95% CI, 0.85-1.35), 1.01 (95% CI, 0.79-1.29), and 1.01 (95% CI, 0.71-1.43), respectively. A BMI of less than 22.0 was associated with a small increased risk of total mortality and cardiovascular mortality.

Conclusion  These findings indicate that elevated BMI may not be strongly associated with total or cardiovascular mortality among men with previously manifested coronary artery disease.

Author Affliations: Evans Department of Medicine and Whittaker Cardiovascular Institute, Boston University School of Medicine (Dr Widlansky), Division of Preventive Medicine, Brigham and Women's Hospital (Drs Sesso, Rexrode, Manson, and Gaziano), Department of Epidemiology, Harvard School of Public Health (Drs Sesso, Manson, and Gaziano), Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Medical Center (Dr Gaziano), and Department of Ambulatory Care and Prevention, Harvard Medical School (Dr Gaziano), Boston, Mass.

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