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Biomedical subjects

A G Shaper

Publications and source records attributed to A G Shaper.

At least 73 records · Page 4Linked to original sources
PubMed1996

Blood pressure and cancer in middle-aged British men.

BACKGROUND: This paper examines the relationship between blood pressure and cancer mortality. METHODS: A prospective study of 7735 middle-aged men drawn at random from one general practice in each of 24 British towns. RESULTS: During a mean follow-up period of 12.75 years there were 351 deaths from cancers. The relationship between blood pressure and cancer differed with respect to follow-up period. In the first 5 years of follow-up, a significant inverse relationship was seen between systolic (SBP) and diastolic blood pressure (DBP) and cancer mortality even after adjustment for age, smoking, social class, physical activity, alcohol intake, body mass index, diabetes, pre-existing ischaemic heart disease, use of antihypertensive drugs, cholesterol, heart rate and serum albumin. In the subsequent follow-up period (5.1-12.75 years) a significant positive association was seen between SBP (but not DBP) and risk of cancer mortality, even after adjustment for the other risk factors. Men in the top fifth of SBP ( > or = 161 mmHg) showed over a 50% increase in risk of cancer mortality compared to men in the bottom quintile (RR = 1.56 95% CI 95% CI: 1.04-2.38). This positive relationship between SBP and cancer was seen only in current cigarette smokers. Use of antihypertensive drugs was not associated with cancer mortality. CONCLUSION: The association of elevated SBP with increased risk of cancer mortality seen only in current smokers warrants the search for factors which affect SBP, interact with smoking and are potentially carcinogenic.

Adult↗
PubMed1996

Cigarette smoking in British men and selection for coronary artery bypass surgery.

OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.

Adult↗
PubMed1996

Patterns of alcohol intake and risk of stroke in middle-aged British men.

BACKGROUND AND PURPOSE: The relationship between the pattern of alcohol intake and the risk of stroke is unclear, in particular the increased risk observed in abstainers and the possible protective effect of light to moderate drinking. For that reason, we examined in a large prospective study the role of alcohol consumption in the risk of a first major cerebrovascular event (stroke). METHODS: We prospectively studied 7735 middle-aged men drawn from general practices in 24 British towns. With exclusion of those who had recall of physician diagnosis of ischemic heart disease or stroke, data were available for 7273 men all followed for 13.5 years, with 216 major stroke events (fatal and nonfatal). RESULTS: Compared with occasional drinkers, nondrinkers (lifelong abstainers plus ex-drinkers) had an increased risk of stroke even after adjustment for age, lifestyle factors, and preexisting cardiovascular disease (relative risk [RR] = 1.6; 95% CI, 1.0 to 2.7). All regular weekend drinkers (1 to 2, 3 to 6, and > 6 drinks/d) and daily 1 to 2 and 3 to 6 drinkers showed no significant difference in adjusted risk of stroke compared with occasional drinkers. Heavy drinkers (daily > 6 drinks) showed significantly increased risk evident within the first 8 years of follow-up only (RR = 1.9; 95% CI, 1.0 to 3.5); however, this finding was attenuated after additional adjustment for systolic blood pressure (RR = 1.5; 95% CI, 0.8 to 2.7). Information obtained 5 years after screening was used to separate lifelong abstainers and ex-drinkers. On subsequent 8.5 years of follow-up, both groups showed similar increased risk (RR = 1.5) compared with occasional drinkers, but the risk in ex-drinkers was reduced after adjustment for lifestyle factors and cardiovascular disease status (RR = 1.2). Lifelong abstainers, however, showed an increase in risk after adjustment of 1.8 (95% CI, 0.7 to 4.6). CONCLUSIONS: Heavy drinking is associated with an increased risk of total stroke that is largely mediated through blood pressure. The apparent increased risk seen in lifelong abstainers but not in ex-drinkers or occasional drinkers is unexplained but is unlikely to be attributed to abstinence from alcohol. There is no convincing evidence that light or moderate drinking is beneficial for stroke risk compared with occasional drinking.

Adult↗
PubMed1996

History of parental death from stroke or heart trouble and the risk of stroke in middle-aged men.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the effect of a history of parental death from stroke or heart trouble on the risk of major stroke events (fatal and nonfatal) in middle-aged British men. METHODS: A prospective study was undertaken of 7735 middle-aged men, drawn at random from general practices in 24 British towns, who were followed up for an average of 14.8 (range, 13.5 to 16.0) years. RESULTS: In the 7683 men providing information on at least one of their parents, there were 278 major stroke events and 947 major ischemic heart disease events. A history of death from stroke or heart trouble in mother or father was associated with a significantly increased risk of stroke independent of other risk factors, including hypertension. The association is due almost entirely to an increased risk of nonfatal stroke. In comparison with men whose parents were still alive or who had no history of parental death from either heart trouble or stroke, the adjusted relative risk of stroke in men with a history of parental stroke death was 1.4 (95% confidence interval [CI], 1.1 to 2.0; P = .02), and in men with parental heart trouble death, the relative risk was 1.3 (95% CI, 1.0 to 1.7; P = .04). The positive relationships were present whether the parental death occurred before or after 70 years of age. A parental death from stroke was not associated with increased risk of an ischemic heart disease event, although the latter was significantly associated with a history of parental death from heart trouble. CONCLUSIONS: Although factors such as hypertension and smoking are of major importance in the etiology of stroke, there is a link between a history of parental death from cardiovascular disease (stroke or heart trouble) and the risk of stroke that appears to be independent of the established risk factors.

Adult↗
PubMed1996

Hematocrit and risk of NIDDM.

There is limited evidence that raised hematocrit levels may be associated with insulin resistance, which links cardiovascular disease with NIDDM. The association between hematocrit level at screening and the subsequent development of physician-diagnosed NIDDM during 12.8 years of follow-up was examined in a prospective study of 7,735 middle-aged men drawn at random from general practice in 24 British towns. With the exclusion of men with missing hematocrit data and men with diabetes at screening, data were available for 7,193 men, in whom there were 187 new cases of NIDDM during follow-up. The risk of NIDDM increased significantly with increasing hematocrit levels. There was more than a fourfold increase in relative risk (RR) of diabetes among men with a hematocrit of > or = 48% relative to those with a hematocrit <42%, adjusted for age and BMI (RR 4.5; 95% CI 2.5-6.3). On further adjustment for predictors of NIDDM with which hematocrit is correlated, there remained a strong linear association with the risk of diabetes. There was a nearly fourfold increased risk of NIDDM in the highest relative to the lowest hematocrit group in the fully adjusted proportional hazard model (RR 3.6; 95% CI 1.7-7.6). The strong positive association between hematocrit level and risk of diabetes was seen even after exclusion of men with preexisting ischemic heart disease. The findings suggest that a raised hematocrit level, which is a major determinant of whole blood viscosity, should be added to the cluster of risk factors that link NIDDM with atheromatous, vascular disease.

Adult↗
PubMed1996

Obesity and cardiovascular disease.

The strong and consistent relationship observed between body weight and blood pressure develops early in life, and overweight/obesity in adult life is a good predictor of hypertension. Weight reduction leads to a decrease in blood pressure and prevention of weight increase lowers the incidence of hypertension, but obesity is not necessarily the direct cause of raised blood pressure. Obesity is not established as an independent risk factor for stroke beyond its association with other risk factors. Obesity is a relatively weak risk factor for coronary heart disease (CHD) but it is closely associated with almost all other coronary risk factors. Thus, becoming obese on a Western high fat diet, with development of excess central fat, promotes atherogenesis through a wide range of biochemical and hormonal parameters, including insulin sensitivity. The obesity-CHD relationship is further confused by the weight loss associated with smoking and smoking-related disease, and is confounded by risk factors that accompany the development and maintenance of obesity. Weight loss in middle-aged populations does not apparently lower CHD incidence, possibly because of lack of specificity in methods of weight reduction. Irrespective of the mechanisms involved, early prevention of atherogenic weight gain in young adulthood is an important public health goal towards the control of hypertension and CHD.

Cardiovascular Diseases↗
PubMed1995

Prospective study of serum total homocysteine concentration and risk of stroke in middle-aged British men.

Moderate hyperhomocysteinaemia is common in the general population and has been linked with cardiovascular disease. However, there are no data from prospective, population-based studies. We examined the association between serum total homocysteine (tHcy) concentration and stroke in a nested case-control study within the British Regional Heart Study cohort. Between 1978 and 1980 serum was saved from 5661 men, aged 40-59 years, randomly selected from the population of one general practice in each of 18 towns in the UK. During follow-up to December, 1991, there were 141 incident cases of stroke among men with no history of stroke at screening. Serum tHcy was measured in 107 cases and 118 control men (matched for age-group and town, without a history of stroke at screening, who did not develop a stroke or myocardial infarction during follow-up). tHcy concentrations were significantly higher in cases than controls (geometric mean 13.7 [95% CI 12.7-14.8] vs 11.9 [11.3-12.6] mumol/L; p = 0.004). There was a graded increase in the relative risk of stroke in the second, third, and fourth quarters of the tHcy distribution (odds ratios 1.3, 1.9, 2.8; trend p = 0.005) relative to the first. Adjustment for age-group, town, social class, body-mass index, hypertensive status, cigarette smoking, forced expiratory volume, packed-cell volume, alcohol intake, diabetes, high-density-lipoprotein cholesterol, and serum creatinine did not attenuate the association. These findings suggest that tHcy is a strong and independent risk factor for stroke.

Adult↗
PubMed1995

Marital status, change in marital status, and mortality in middle-aged British men.

The effects of marital status and change in marital status on mortality among middle-aged British men were examined in a prospective cohort study, the British Regional Heart Study. This is a nationally representative cohort of men selected at random from general medical practices in 24 towns in England, Wales, and Scotland. It comprises 7,735 men aged 40-59 recruited in 1978-1980 and followed up for 11.5 years. Marital status and a wide range of biologic and lifestyle variables were measured at screening, and changes in marital status were assessed after 5 years. Single (never-married) men had an increased risk of cardiovascular disease mortality (relative risk (RR) = 1.5, 95% confidence interval (CI) 1.0-2.2) and noncancer, noncardiovascular mortality (RR = 1.8, 95% CI 1.1-3.3) after adjustment for potentially confounding variables: age, social class, smoking, recall of ischemic heart disease, recall of diabetes mellitus, use of antihypertensive drugs, body mass index, physical activity, alcohol intake, employment status, systolic blood pressure, blood cholesterol, and forced expiratory volume in 1 second. Divorced/separated men were not at increased risk of mortality, and widowed men were only at increased risk of other non-cardiovascular disease mortality (RR = 2.4, 95% CI 1.1-5.3). There was no effect of marital status on cancer mortality. Men who divorced during the follow-up period were at increased risk of both cardiovascular disease mortality (RR = 1.9, 95% CI 0.9-3.9) and other non-cardiovascular disease mortality (RR = 4.0, 95% CI 1.5-10.6), but men who became widowed during this time were not at increased risk. The excess mortality among single and recently divorced men was not explained by poor health or by exposure to a wide range of risk factors. It is unlikely that selection bias, chance, or artifact is responsible for the general relation between marital status and mortality. Variable and incomplete control for confounding by socioeconomic status and risk factors for common diseases may explain some of the inconsistencies observed between studies and between different categories of unmarried men (i.e., never-married, widowed, and divorced). It is possible that the social support offered by marriage exerts a protective effect for some men.

Adult↗
PubMed1995

Gamma-glutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes.

The association of serum levels of gamma-glutamyltransferase (GGT) with cardiovascular disease risk factors, and with mortality from all causes, cardiovascular disease, and non-cardiovascular diseases, has been examined in a prospective study of 7,613 middle-aged British men followed for 11.5 years. GGT levels were strongly associated with all-cause mortality, largely due to a significant increase in deaths from ischemic heart disease and other non-cardiovascular disease causes, i.e., non-cancer deaths, in the top quintile of the GGT distribution. No association was seen with cancer mortality. However, GGT was significantly (positively) associated with alcohol intake, body mass index, smoking, preexisting ischemic heart disease, diabetes mellitus, antihypertensive medication, systolic and diastolic blood pressure, total and high density lipoprotein cholesterol, heart rate, and blood glucose, and negatively associated with physical activity and lung function (forced expiratory volume in 1 second (FEV1)). After adjustment for these personal characteristics and biologic variables, elevated GGT (highest quintile > or = 24 unit/liter vs. the rest) was still associated with a significant increase in mortality from all causes (relative risk (RR) = 1.22, 95% confidence interval (CI) 1.01-1.42; n = 818 deaths) and from ischemic heart disease (RR = 1.42, 95% CI 1.12-1.80; n = 332 deaths). The increase in other non-cardiovascular disease causes was of marginal significance (RR = 1.45, 95% CI 0.95-2.20; n = 127 deaths). When examined separately by the presence or absence of preexisting ischemic heart disease, the increased risk of ischemic heart disease mortality was more marked in those with evidence of ischemic heart disease at screening, particularly in those with previous myocardial infarction (RR = 1.67, 95% CI 1.03-2.69; n = 84 deaths). The increased risk of other non-cardiovascular disease deaths was only seen in men without preexisting ischemic heart disease, largely due to an excess of hepatic cirrhosis. In summary, many factors other than alcohol intake are associated with increased levels of GGT, in particular body mass index, diabetes mellitus, and serum total cholesterol. The finding of increased risk of ischemic heart disease mortality seen in men with preexisting ischemic heart disease is related to the severity of the underlying myocardial damage. The biologic significance of raised GGT in men with preexisting ischemic heart disease merits further study.

Adult↗
PubMed1995

Low serum total cholesterol concentrations and mortality in middle aged British men.

OBJECTIVE: To examine the relation between low serum total cholesterol concentrations and causes of mortality. DESIGN: Cohort study of men followed up for an average of 14.8 years (range 13.5-16.0 years). SETTING: One general practice in each of 24 British towns. SUBJECTS: 7735 men aged 40-59 at screening selected at random from the 24 general practices. MAIN OUTCOME MEASURES: Deaths from all causes, cardiovascular causes, cancer, and non-cardiovascular, non-cancer causes. RESULTS: During the mean follow up period of 14.8 years there were 1257 deaths from all causes, 640 cardiovascular deaths, 433 cancer deaths, and 184 deaths from other causes. Low serum cholesterol concentrations (< 4.8 mmol/l), present in 5% (n = 410) of the men, were associated with the highest mortality from all causes, largely due to a significant increase in cancer deaths (age adjusted relative risk 1.6 (95% confidence interval 1.1 to 2.3); < 4.8 v 4.8-5.9 mmol/l) and in other non-cardiovascular deaths (age adjusted relative risk 1.9 (1.1 to 3.1)). Low serum cholesterol concentration was associated with an increased prevalence of several diseases and indicators of ill health and with lifestyle characteristics such as smoking and heavy drinking. After adjustment for these factors in the multivariate analysis the increased risk for cancer was attenuated (relative risk 1.4 (0.9 to 2.0) and the inverse association with other non-cardiovascular, non-cancer causes was no longer significant (relative risk 1.5 (0.9 to 2.6); < 4.8 v 4.8-5.9 mmol/l). The excess risks of cancer and of other non-cardiovascular deaths were most pronounced in the first five years and became attenuated and non-significant with longer follow up. By contrast, the positive association between serum total cholesterol concentration and cardiovascular mortality was seen even after more than 10 years of follow up. CONCLUSION: The association between comparatively low serum total cholesterol concentrations and excess mortality seemed to be due to preclinical cancer and other non-cardiovascular diseases. This suggests that public health programmes encouraging lower average concentrations of serum total cholesterol are unlikely to be associated with increased cancer or other non-cardiovascular mortality.

Adult↗
PubMed1995

Smoking cessation and the risk of stroke in middle-aged men.

OBJECTIVE: To examine the effects of giving up smoking, years since quitting smoking and the quantity of cigarettes smoked, and primary pipe or cigar smoking on the risk of stroke. DESIGN, SUBJECTS, AND SETTING: A prospective study of cardiovascular disease and its risk factors in 7735 men aged 40 through 59 years drawn at random from the age-sex registers of one general practice in each of 24 British towns from 1978 through 1980 (the British Regional Heart Study). MAIN OUTCOME MEASURE: Incidence of fatal and nonfatal major stroke events (strokes) during an average follow-up period of 12.75 years. RESULTS: During the 12.75 years of follow-up, there were 167 major stroke events (43 fatal and 124 nonfatal) in the 7264 men with no recall of previous ischemic heart disease or stroke. After full adjustment for other risk factors, current smokers had a nearly fourfold relative risk (RR) of stroke compared with never smokers (RR, 3.7; 95% confidence interval [CI], 2.0 to 6.9). Ex-cigarette smokers showed lower risk than current smokers but showed excess risk compared with never smokers (RR, 1.7; 95% CI, 0.9 to 3.3; P = .11); those who switched to pipe or cigar smoking showed a significantly increased risk (RR, 3.3; 95% CI, 1.6 to 7.1) similar to that of current light smokers. Primary pipe or cigar smokers also showed increased risk (RR, 2.2; 95% CI, 0.6 to 8.0), but the number of subjects involved was small. The benefit of giving up smoking completely was seen within 5 years of quitting, with no further consistent decline in risk thereafter, but this was dependent on the amount of tobacco smoked. Light smokers (< 20 cigarettes/d) reverted to the risk level of those who had never smoked. Heavy smokers retained a more than twofold risk compared with never smokers (RR, 2.2; 95% CI, 1.1 to 4.3). The age-adjusted RR of stroke in those who quit smoking during the first 5 years of follow-up (recent quitters) was reduced compared with continuing smokers (RR, 1.8; 95% CI, 0.7 to 4.6 vs RR, 4.3; 95% CI, 2.1 to 8.8). The benefit of quitting smoking was observed in both normotensive and hypertensive men, but the absolute benefit was greater in hypertensive subjects. CONCLUSION: Smoking cessation is associated with a considerable and rapid benefit in decreasing the risk of stroke, particularly in light smokers (< 20 cigarettes/d); a complete loss of risk is not seen in heavy smokers. Switching to pipe or cigar smoking confers little benefit, emphasizing the need for complete cessation of smoking. The absolute benefit of quitting smoking on risk of stroke is most marked in hypertensive subjects.

Cerebrovascular Disorders↗
PubMed1995

Risk factors for sudden cardiac death in middle-aged British men.

BACKGROUND: Risk factors specific to sudden cardiac death (SCD), ie, death within 1 hour after onset of symptoms, have been poorly identified, although recent findings from the present study incriminate heavy drinking and elevated heart rate. This paper examines the relations between a wide range of established and potential risk factors for ischemic heart disease (IHD) and SCD to identify independent risk factors for SCD and factors that might particularly or specifically relate to SCD. METHODS AND RESULTS: We present a prospective study of a cohort that was drawn from general practices in 24 British towns of 7735 middle-aged men who were followed up for 8 years. During 8 years of follow-up, the men experienced 488 major IHD events (nonfatal and fatal), of which 117 (24%) were classified as SCD. Age, preexisting IHD, arrhythmia, systolic blood pressure, blood cholesterol, elevated heart rate (> or = 90 beats per minute), physical activity (all, P < .05), and, to a lesser extent, smoking (P = .06), HDL cholesterol (P < .07), and elevated hematocrit (> or = 46%, P < .09) emerged as independent risk factors for SCD after adjustment for a wide range of factors. Diabetes was not found to be associated with SCD, and forced expiratory volume in 1 second, body mass index, white blood cell count, and antihypertensive drugs were not associated with risk of SCD after adjustment. When examined in relation to non-sudden IHD deaths and nonfatal myocardial infarction, elevated heart rate, heavy drinking, and arrhythmia emerged as factors that appear to be specific or particular to SCD. These three factors and age and blood cholesterol were associated with an increased risk of SCD in men both with and without preexisting IHD. Physical activity, systolic blood pressure, and current smoking were associated with SCD only in men without preexisting IHD. HDL cholesterol and hematocrit were strong predictors of SCD only in men with preexisting IHD. CONCLUSIONS: Three risk factors appear to be specific or particular to the risk of SCD, and these and other risk factors operate differently in patients with versus those without preexisting IHD. These findings have implications for the causes and prevention of SCD.

Adult↗
PubMed1995

Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men.

OBJECTIVE: To determine the risk factors for noninsulin dependent diabetes in a cohort representative of middle aged British men. DESIGN: Prospective study. SUBJECTS AND SETTINGS: 7735 men aged 40-59, drawn from one group practice in each of 24 towns in Britain. Known and probable cases of diabetes at screening (n = 158) were excluded. MAIN OUTCOME MEASURES: Non-insulin dependent diabetes (doctor diagnosed) over a mean follow up period of 12.8 years. RESULTS: There were 194 new cases of non-insulin dependent diabetes. Body mass index was the dominant risk factor for diabetes, with an age adjusted relative risk (upper fifth to lower fifth) of 11.6; 95% confidence interval 5.4 to 16.8. Men engaged in moderate levels of physical activity had a substantially reduced risk of diabetes, relative to the physically inactive men, after adjustment for age and body mass index (0.4; 0.2 to 0.7), an association which persisted in full multivariate analysis. A nonlinear relation between alcohol intake and diabetes was observed, with the lowest risk among moderate drinkers (16-42 units/week) relative to the baseline group of occasional drinkers (0.6; 0.4 to 1.0). Additional significant predictors of diabetes in multivariate analysis included serum triglyceride concentration, high density lipoprotein cholesterol concentration (inverse association), heart rate, uric acid concentration, and prevalent coronary heart disease. CONCLUSION: These findings emphasise the interrelations between risk factors for non-insulin dependent diabetes and coronary heart disease and the potential value of an integrated approach to the prevention of these conditions based on the prevention of obesity and the promotion of physical activity.

Adult↗
PubMed1995

Weight change and risk of heart attack in middle-aged British men.

BACKGROUND: Both weight gain and weight loss have been associated with increased risk of cardiovascular disease mortality in recent studies from the US. This finding has led to concern and uncertainty about appropriate advice for overweight and obese subjects. METHODS: In a prospective study of cardiovascular disease, the relationship between weight change over a 5-year period and subsequent risk of a heart attack during a further 6.5 year follow-up was examined in 7100 middle-aged British men. RESULTS: Over half of the men remained stable (< 4% change in bodyweight) and served as the reference group; 31% gained weight and 13% lost weight. The 6445 men free from a history of coronary heart disease experienced 318 heart attacks, fatal and non-fatal, during the 6.5 years. Men who gained 4-10% bodyweight had the lowest rate of heart attack, although this was not significantly different from the stable group. The men who lost weight had an increased risk of heart attack, which after adjustment (for age, recall of doctor-diagnosed hypertension and diabetes and other coronary risk factors i.e. serum total cholesterol, blood pressure, social class, initial body mass index (BMI) and lung function (FEV1), and smoking status at screening and 5 years later), was of a similar level of risk to the stable group. The men who gained > 10% bodyweight had a significantly increased risk of a heart attack after the above adjustment (P < 0.05). When the effect of weight change was examined according to initial BMI, those men with a BMI < 25 kg/m2 who lost weight had a marginally increased relative risk of heart attack after full adjustment (P = 0.06), while men who were overweight (BMI 25-27.9 kg/m2) or obese (BMI > or = 28 kg/m2) showed no benefit from weight loss. A small amount of weight gain (4-10%) in the overweight or obese men was associated with decreased risk, whereas considerable weight gain (> 10%) was associated with increased risk, both findings reaching statistical significance in the overweight men (P < 0.05 and P < 0.001 respectively). CONCLUSIONS: Considerable weight gain (> 10%) in middle-aged men is associated with increased risk of a heart attack, but weight loss does not appear to reduce risk even in the overweight or obese.

Adult↗