Obesity, behavioral lifestyle factors, and risk of acute coronary events.

BACKGROUND Whether physical activity reduces the impact of obesity on the risk of acute coronary events is much debated. However, little is known about the role of other potentially modifiable lifestyle factors in combination with obesity. METHODS AND RESULTS We followed up 54,783 women and men from the prospective Danish Diet, Cancer and Health study who were 50 to 64 years at baseline (1993 to 1997) and free of coronary artery disease and cancer. During a median of 7.7 years, 1127 incident cases of acute coronary syndrome (ACS) occurred. After multivariable adjustments, each unit of body mass index was associated with a 5% and 7% higher risk of ACS among women and men, respectively (both P<0.0001 for trend). Overweight (body mass index, 25 to 29.9 kg/m(2)) and obesity (body mass index >or=30 kg/m(2)) were associated with a higher risk of ACS among the physically active and inactive, in nonsmokers and smokers, and among those who adhered more or less to a heart-healthy dietary pattern. Obese individuals who were active 1 to 3.5 h/wk had a lower risk than sedentary, obese individuals. In addition, obese nonsmokers had a lower risk than obese smokers. Adherence to a healthy diet was associated with a lower risk of ACS; however, the relative risk was not different among obese individuals with the most healthy diet versus obese individuals with a less healthy diet. CONCLUSIONS Obesity confers an elevated risk of ACS in both healthy and less healthy subgroups of lifestyle behaviors. Adherence to healthy lifestyle behaviors was associated with a lower risk even among obese individuals.