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A Prospective Study of Obesity and Risk of Coronary Heart Disease Among Diabetic Women

¹ Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
² Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
³ Channing Laboratory, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
⁴ Division of Preventive Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
⁵ Division of Women’s Health, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts

OBJECTIVE—To examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes.

RESEARCH DESIGN AND METHODS—We followed 5,897 women with type 2 diabetes in the Nurses’ Health Study for 20 years. Women were aged 40–74 years and had no history of cardiovascular disease or cancer at the beginning of the follow-up period. BMI values from three time points (age 18 years, year 1976, and current) were derived from the reported height (1976) and corresponding reported weight. Weight changes between age 18 years and 1976 and after diagnosis of diabetes were calculated. Women reported diagnoses of diabetes and CHD every 2 years. Incident CHD cases were confirmed by medical record review.

RESULTS—During follow-up, we documented 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI was strongly associated with increased risk of CHD among diabetic women. The multivariate relative risks across increasing categories of BMI (<23.0, 23.0–24.9, 25.0–26.9, 27.0–29.9, 30.0–34.9, and 35.0 kg/m²) were 1.0, 1.58, 1.85, 1.95, 2.80, and 3.21, respectively (P for trend <0.001). Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes was not associated with risk of CHD.

CONCLUSIONS—These findings provide strong evidence that obesity and weight gain before diagnosis of diabetes are associated with future risk of CHD among women with type 2 diabetes.

Abbreviations: CHD, coronary heart disease • MI, myocardial infarction • NHS, Nurses’ Health Study • RR, relative risk

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