Atherosclerosis leads to the development of CHD. Individuals with atherosclerosis can be identified by the ultrasound examination of carotid intimal-medial thickness (IMT). Evidence from the Bogalusa Heart Study found that the carotid IMT at age 35 yr was correlated with BMI measured throughout life (85). Longitudinal evidence from the Muscatine Study suggests that increased adipose tissue in youth is correlated with a greater risk of developing coronary artery calcification in later life and that this association was stronger in males (86). Berenson et al. (87) observed a similar association in young adults, particularly among young men, between obesity and the development of atherosclerotic lesions as evidenced by fatty streaks and/or fibrous plaque lesions.
Obesity may be an independent risk factor for ischemic heart disease. However, numerous studies have been unable to confirm this association because of the short time period of observation. Indeed, the association between obesity and ischemic heart disease seems evident only after two decades of follow-up (76). The Manitoba Heart Study reported that a high BMI was significantly associated with development of myocardial infarction, coronary insufficiency, and sudden death (76).
A cross-sectional study by Takami et al. (88) of 849 Japanese men aged 20 to 78 yr investigated the relationship between body fatness (particularly abdominal fat) and carotid atherosclerosis. They found that general adiposity (as measured by BMI), WC, waist-to-hip ratio (WHR), abdominal subcutaneous fat, and intra-abdominal fat were all correlated with carotid IMT after adjustment for age and smoking habits. Adjustment for BMI eliminated all other associations except those of WHR with IMT, suggesting that in this population abdominal fat is not as strongly associated with carotid atherosclerosis as is general body fatness. The Progetto ATENA study is a large (more than 5000 participants) ongoing investigation of the causes of CVD and cancer in Italian females aged 30 to 69 yr. Within that study, De Michele et al. (89) reported on a sub-sample of 310 women and concluded that BMI and WHR were significant predictors of carotid wall thickness independent of other cardiovascular risk factors (age, BP, lipid abnormalities, and fasting insulin). As BMI increased, IMT increased along with other coronary risk factors (systolic blood pressure [SBP], diastolic blood pressure [DBP], triglycerides, fasting glucose, insulin, and lower high-density lipoprotein [HDL] cholesterol concentrations).
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