Body mass index, hypertension and 5-year coronary heart disease incidence in middle aged men:: the PRIME study

Objective The aim of the present study was to assess the joint contribution of hypertension and body mass index to coronary heart disease risk. Design Prospective study on men aged 50-59 years free of coronary heart disease at entry recruited in three regions of France (n = 7359) and in Northern Ireland (n = 2399). Participants The recruitment frame was based on industry and various employment groups, on health screening centers and general practice. Main outcome Incident cases of effort angina, unstable angina, myocardial infarction and coronary death were recorded over a 5-year follow-up. Results Compared with the reference group [body mass index (BMI) < 25 kg/m(2)], the relative risk of coronary event was higher in the second (25 less than or equal to BMI < 27.6) and third BMI tertiles: 1.27 (95% confidence interval 0.94-1.70) and 1.14 (0.84-1.56) after adjustment for confounders and covariates, including diabetes, hypertension and lipoprotein levels. Further analyses revealed a significant interaction between hypertension and BMI on coronary disease risk (P < 0.05), suggesting that hypertension modifies coronary heart disease (CHD) risk attributable to BMI. Among hypertensive men, the relative risk of coronary heart disease was 1.34 (0.85-2.11) and 1.61 (1.04-2.50) in the second and third BMI tertiles, respectively. In normotensive men, BMI was not associated with CHD risk; relative risk 1.25 (0.85-1.85) and 0.66 (0.40-1.09) in the second and third BMI, respectively. Conclusion These results indicate that hypertension and overweight jointly increase coronary heart disease risk. (C) 2003 Lippincott Williams Wilkins.