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The Multi-Ethnic Study of Atherosclerosis

Gregory L. Burke, MD, MS; Alain G. Bertoni, MD, MPH; Steven Shea, MD, MS; Russell Tracy, PhD; Karol E. Watson, MD, PhD; Roger S. Blumenthal, MD; Hyoju Chung, PhD; Mercedes R. Carnethon, PhD

Arch Intern Med. 2008;168(9):928-935.

Background  To assess the importance of the obesity epidemic on cardiovascular disease (CVD) risk, we determined the prevalence of obesity and the relationship of obesity to CVD risk factors and subclinical vascular disease.

Methods  The Multi-Ethnic Study of Atherosclerosis is an observational cohort study involving 6814 persons aged 45 to 84 years who were free of clinical CVD at baseline (2000-2002). The study assessed the association between body size and CVD risk factors, medication use, and subclinical vascular disease (coronary artery calcium, carotid artery intimal medial thickness, and left ventricular mass).

Results  A large proportion of white, African American, and Hispanic participants were overweight (60% to 85%) and obese (30% to 50%), while fewer Chinese American participants were overweight (33%) or obese (5%). Hypertension and diabetes were more prevalent in obese participants despite a much higher use of antihypertensive and/or antidiabetic medications. Obesity was associated with a greater risk of coronary artery calcium (17%), internal carotid artery intimal medial thickness greater than 80th percentile (32%), common carotid artery intimal medial thickness greater than 80th percentile (45%), and left ventricular mass greater than 80th percentile (2.7-fold greater) compared with normal body size. These associations persisted after adjustment for traditional CVD risk factors.

Conclusions  These data confirm the epidemic of obesity in most but not all racial and ethnic groups. The observed low prevalence of obesity in Chinese American participants indicates that high rates of obesity should not be considered inevitable. These findings may be viewed as indicators of potential future increases in vascular disease burden and health care costs associated with the obesity epidemic.

Author Affiliations: Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina (Drs Burke and Bertoni); Departments of Medicine and Epidemiology, Columbia University School of Medicine, New York, New York (Dr Shea); Department of Pathology and Biochemistry, University of Vermont School of Medicine, Burlington (Dr Tracy); Department of Medicine, University of California, Los Angeles, UCLA School of Medicine (Dr Watson); Department of Cardiology, The Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, Maryland (Dr Blumenthal); Department of Biostatistics, University of Washington, Seattle (Dr Chung); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Carnethon).

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