Relationship between the Pattern of Coronary Artery Disease Risk Factors and Lipid Ratios with Five Groups of Body Mass Index in 28566 Healthy Adults

  • Zinat Nadia Hatmi Mail Department of Social Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Mitra Mahdavi-Mazde Department of Nephrology, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Saeid Hashemi-Nazari Health City Office, Tehran Municipality, Tehran, Iran.
  • Ebrahim Hajighasemi Health City Office, Tehran Municipality, Tehran, Iran.
  • Behnaz Nozari Research Center of Iranian Tissue Bank, Tehran, Iran.
  • Nasrin Jalilian Department of Obstetric and Gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  • Azita Mahdavi National Behzisti Organization, Tehran, Iran.
Coronary artery disease, Risk assessment, Body mass index, Lipid ratios


Pattern of the coronary artery disease (CAD) risk factors across body mass index (BMI) categories remains uncertain. There is a different threshold of obesity for increasing cardiovascular hazard across populations, accordingly recognition and management of obesity and overweight can guide better control of CAD epidemic in the national level. To determine the discrepancy in the prevalence of CAD risk factors across five BMI categories. A population based survey of 28566 participants recruited to medical screening of taxi drivres in Tehran (MSTDT) was designed. According to a standardized protocol data on CAD risk factors were obtained by taking medical history, examination and laboratory tests. After adjustment for age, sex, literacy, smoking, systolic blood pressure (SBP), fasting blood sugar (FBS), and LDL-C/HDL-C ratio, these CAD risk factors of diastolic blood pressure (DBP)>90 mmHg, hypertriglyceridemia, high triglyceride/ HDL-C ratio, hypercholesterolemia, and high cholesterol/HDL-C ratio were increased significantly across five incremental categories of BMI. Prevalence of DBP> 90 mmHg, hypertriglyceridemia, hyper cholesterolemia and ratios of cholesterol/ HDL-C and TG/HDL-C increased considerably across five groups of BMI. This pattern is different from previous research and our results endorsed more features of pattern of CAD risk factors across BMI categories.


Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM, Narayan KM, Williamson DF. Secular trends in cardiovascular disease risk factorsaccording to body mass index in US adults. JAMA 2005;293(15):1868-74.

Burke GL, Bertoni AG, Shea S, Tracy R, Watson KE, Blumenthal RS, Chung H, Carnethon MR. The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease: the Multi-Ethnic Study of Atherosclerosis. Arch Intern Med 2008;168(9):928-35.

Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P, van Dam RM, Hu FB,Visscher TL, Menotti A, Thorpe RJ Jr, Jamrozik K, Calling S, Strand BH, Shipley MJ; for the BMI-CHD Collaboration Investigators. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300000 persons. Arch Intern Med 2007;167(16):1720-8.

Weinstein AR, Sesso HD, Lee IM, Rexrode KM, Cook NR, Manson JE, Buring JE, Gaziano JM. The joint effects of physical activity and body mass index on coronary heart disease risk in women. Arch Intern Med 2008;168(8):884-90.

McLaughlin T, Abbasi F, Lamendola C, Reaven G. Heterogeneity in the prevalence of risk factors for cardiovascular disease and type 2 diabetes mellitus in obese individuals. Arch Intern Med 2007; 167(7):642-8.

Tucker AM, Vogel RA, Lincoln AE, Dunn RE, Ahrensfield DC, Allen TW, Castle LW, Heyer RA, Pellman EJ, Strollo PJ Jr, Wilson PW, Yates AP. Prevalence of cardiovascular disease risk factors among National Football League players. JAMA 2009;301(20):2111-9.

Wilson PW, D'Agostino RB, Sullivan L, Parise H, KannelWB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002;162(16):1867-72.

Kannel WB, D'Agostino RB, Cobb JL. Effect of weight on cardiovascular disease. Am J Clin Nutr 1996;63(3 Suppl):419S-422S.

Shaper AG, Wannamethee SG, Walker M. Body weight:implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men. BMJ 1997;314(7090):1311-7.

Hatmi ZN, Tahvildari S, Gafarzadeh Motlag A, Sabouri Kashani A. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMCCardiovasc Disord 2007;7:32.

Sewell JL, Malasky BR, Gedney CL, Gerber TM, Brody EA, Pacheco EA, Yost D, Masden BR, Galloway JM. The increasing incidence of coronary artery disease and cardiovascular risk factors among a Southwest Native American tribe: the White Mountain Apache Heart Study. Arch Intern Med 2002;162(12):1368-72.

Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003;290(7):898-904.

Weverling-Rijnsburger AW, Jonkers IJ, van Exel E,Gussekloo J, Westendorp RG. High-density vs low-density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age. Arch Intern Med 2003;163(13):1549-54.

Faletra FF, Klersy C, D'Angeli I, Penco M, Procaccini V, Pasotti E, Marcolongo A, Pedrazzini GB, De Castro S, Scappaticci M, Moccetti T, Auricchio A. Relation between coronary atherosclerotic plaques and traditional risk factors in people with no history of cardiovascular disease undergoing multi-detector computed coronary angiography. Heart 2009;95(15):1265-72.

Lamarche B, Tchernof A, Mauriège P, Cantin B, Dagenais GR, Lupien PJ, Després JP. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998;279(24):1955-61.

Shaukat N, de Bono DP, Jones DR. Like father like son? Sons of patients of European or Indian origin with coronary artery disease reflect their parents' risk factor patterns. Br Heart J 1995;74(3):318-23.

Wannamethee SG, Shaper AG, Walker M, Ebrahim S. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Arch Intern Med 1998;158(22):2433-40.

Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA 2003;290(7):932-40.

Tousoulis D, Antoniades C, Stefanadis C. Assessinginflammatory status in cardiovascular disease. Heart 2007;93(8):1001-7.

Bennet A, Di Angelantonio E, Erqou S, Eiriksdottir G, Sigurdsson G, Woodward M, Rumley A, Lowe GD, Danesh J, Gudnason V. Lipoprotein(a) levels and risk of future coronary heart disease: largescale prospective data. Arch Intern Med 2008; 168(6):598-608. Erratum in: Arch Intern Med 2008;168(10):1089, Arch Intern Med 2008;168(10): 1096.

Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA 2005;294(3):326-33.

Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: metaanalyses of prospective studies. JAMA 1998; 279(18):1477-82.

Ranjit N, Diez-Roux AV, Shea S, Cushman M, Seeman T,Jackson SA, Ni H. Psychosocial factors and inflammation in the multi-ethnic study of atherosclerosis. Arch Intern Med 2007;167(2):174-81.

Stewart JC, Janicki DL, Muldoon MF, Sutton-Tyrrell K, Kamarck TW. Negative emotions and 3-year progressionof subclinical atherosclerosis. Arch Gen Psychiatry 2007;64(2):225-33.

Frasure-Smith N, Lespérance F. Depression and anxiety aspredictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 2008;65(1):62-71.

Gluckman TJ, Baranowski B, Ashen MD, Henrikson CA, McAllister M, Braunstein JB, Blumenthal RS. Apractical and evidence-based approach to cardiovasculardisease risk reduction. Arch Intern Med 2004;164(14):1490-500.

Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002;162(16):1867-72.

Wessel TR, Arant CB, Olson MB, Johnson BD, Reis SE,Sharaf BL, Shaw LJ, Handberg E, Sopko G, Kelsey SF,Pepine CJ, Merz NB. Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women. JAMA 2004;292(10):1179-87.

Denney-Wilson E, Hardy LL, Dobbins T, Okely AD, Baur LA. Body mass index, waist circumference, and chronic disease risk factors in Australian adolescents. Arch PediatrAdolesc Med 2008;162(6):566-73.

Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, Goto S, Liau CS, Richard AJ, Röther J, Wilson PW; REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295(2):180-9.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet 2004;364(9438):937-52.

How to Cite
Hatmi ZN, Mahdavi-Mazde M, Hashemi-Nazari SS, Hajighasemi E, Nozari B, Jalilian N, Mahdavi A. Relationship between the Pattern of Coronary Artery Disease Risk Factors and Lipid Ratios with Five Groups of Body Mass Index in 28566 Healthy Adults. Acta Med Iran. 49(11):730-736.