Associations of serum lipid concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden

Abstract

Objective - To examine association of different measures of serum lipid concentration and obesity with mortality in women. Design - Prospective observational study initiated in 1968-9, follow up examination after 12 years, and follow up study based on death certificates after 20 years. Setting - Gothenburg, Sweden. Subjects - 1462 randomly selected women aged 38-60 at start of study. Main outcome measures - Total mortality and death from myocardial infarction as predicted by serum cholesterol and triglyceride concentrations, body mass index, and ratio of circumference of waist to circumference of hips. Results - 170 women died during follow up, 26 from myocardial infarction. Serum triglyceride concentration and waist:hip ratio were significantly associated with both end points (relative risk of total mortality for highest quarter of triglyceride concentration v lower three quarters 1·86 (95% confidence interval 1·30 to 2·67); relative risk for waist:hip ratio 1·67 (1·18 to 2·36)). These associations remained after adjustment for background variables. Serum cholesterol concentration and body mass index were initially associated with death from myocardial infarction, but association was lost after adjustment for background variables. Serum triglyceride concentration and waist:hip ratio were independently predictive of both end points (logistic regression coefficient for total mortality for triglyceride 0·514 (SE 0·150), p=0·0006; coefficient for waist:hip ratio 7·130 (1·92), p=0-0002) whereas the other two risk factors were not (coefficient for total mortality for cholesterol concentration -0·102 (0·079), p=0·20; coefficient for body mass index -0·051 (0·027), p=0·05). Conclusions - Lipid risk profile appears to be different in men and women given that serum triglyceride concentration was an independent risk factor for mortality while serum cholesterol concentration was not. Consistent with previous observations in men, localisation of adipose tissue was more important than obesity per se as risk factor in women.