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Public Health

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Original Research

Physical activity, abdominal obesity and the risk of coronary

heart disease: A Korean national sample study

J. Kim a, H.-R. Han b,*

a
Department of Nursing, Gachon University, Seongnam, South Korea
b
School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205-2110, USA

article info summary

Article history: Objectives: To examine the interaction between physical activity and abdominal obesity in
Received 24 October 2010 relation to the Framingham Risk Score (FRS) for predicting the 10-year risk of coronary
Received in revised form heart disease (CHD) using a representative sample of Korean adults.
29 September 2011 Study design: Cross-sectional study.
Accepted 25 January 2012 Methods: Drawing from the 2007 Korean National Health and Nutrition Examination Survey
Available online 23 March 2012 (NHANES IV-1), data from 2112 adults aged 30e74 years were analysed. The risk of CHD was
calculated according to the FRS, and odds ratios (ORs) were analysed for the at-risk group
Keywords: (probability > 10%) with multivariate logistic regression.
Exercise Results: Compared with physically active men with a normal waist circumference (WC),
Abdominal obesity inactive men with a large WC had an OR for CHD risk of 2.91 [95% confidence interval (CI)
Coronary disease 1.63e5.22]. Compared with active women with a normal WC, inactive women with a large
WC had an OR of 6.37 (95% CI 3.44e11.80). Among women with a normal WC, inactive
women were at increased risk of CHD compared with active women (OR 2.16, 95% CI
1.19e3.93). Among active individuals, both men and women with large WCs were at
increased risk of CHD compared with those with normal WCs.
Conclusions: Abdominal obesity was associated with risk of CHD regardless of the level of
physical activity. The 10-year risk of CHD associated with physical inactivity and abdominal
obesity was much stronger in Korean women than in Korean men. While the importance of
obesity control and physical activity is clear, future interventions should incorporate more
targeted abdominal obesity prevention and control efforts, especially for women.
ª 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Introduction mortality.1e5 Likewise, prospective cohort studies and

Physical activity and obesity are well-known factors that play
significant roles in the development of coronary heart disease
(CHD). Considerable evidence indicates that sedentary indi-
viduals have an increased risk of CHD and overall
population-based surveys have revealed that obesity is an
independent risk factor for CHD.6,7
A few recent studies conducted in Western countries seem
to suggest interesting interplays between physical activity and
obesity in association with CHD. For example, Wessel et al.8

* Corresponding author. Tel.: þ1 410 6142669; fax: þ1 410 614 1446.

E-mail address: hhan@son.jhmi.edu (H.-R. Han).
0033-3506/$ e see front matter ª 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.puhe.2012.01.034
 p u b l i c h e a l t h 1 2 6 ( 2 0 1 2 ) 4 1 0 e4 1 6
found that individuals with a sedentary lifestyle had a higher
likelihood of having coronary artery disease than individuals
with an active lifestyle, while obesity was not independently
associated with adverse cardiovascular events. The interplay
between physical activity and obesity may differ by gender.
For example, inactive women with a large waist circumfer-
ence (WC), as a measure of obesity, had a greater risk of CHD
than inactive men with a large WC.7,9 However, no studies
were found to examine the association between physical
activity and obesity in relation to risk of CHD in East Asian
populations.
Over the past decade, CHD has emerged as a leading cause
of death in some East Asian countries such as Korea.10 In 2009,
the age-adjusted mortality rate of CHD was 26.0 per 100,000
persons in Korea, compared with 21.4 per 100,000 persons in
2000.11 While both physical activity and obesity represent key
lifestyle factors associated with CHD, investigating the inter-
play between these two factors is an important first step in
attempting to identify high-risk populations and target CHD
prevention efforts in Korea. The aim of this study was to
examine the interaction between physical activity and obesity
in relation to risk of CHD using data from the most recent
Korean national health survey. The results will be useful to
suggest evidence-based lifestyle recommendations for CHD
risk reduction in the Korean population.
Methods
Study population
This study was based on data obtained from the Korea
National Health and Nutrition Examination Survey (KNHANES
IVe1, 2007). KNHANES was conducted as a cross-sectional
health survey of nationally representative samples of non-
institutionalized Korean civilians by the Korean Centers for
Disease Control and Prevention. The health interview survey
data used in this study consisted of a self-administered
questionnaire including health behaviours such as alcohol
consumption and physical activity, and a health examination
survey including WC, blood pressure, total cholesterol, high-
density lipoprotein (HDL) cholesterol and fasting blood sugar
tests. Of the 4594 individuals in the 2007 KNHANES, 2112
respondents who were aged 30e74 years, had completed
blood tests, and had no angina or myocardial infarction were
included in this analysis.
Measurements
Level of physical activity
Level of physical activity was measured by the International
Physical Activity Questionnaire which included questions
about frequency, duration and intensity of physical activity
during the prior week.12 For this analysis, the level of physical
activity was categorized into three items.13 Subjects who
reported no physical activity were assigned to the ‘inactive’
group. Subjects were assigned to the ‘active’ group if they
performed moderate physical activity (e.g. tennis doubles,
volleyball, badminton or table tennis) or any other activity
that caused a slight increase in breathing or heart rate for at
411
least 30 min/day on 5 days/week, or if they performed
vigorous physical activity (e.g. running, mountain climbing,
soccer, basketball) or any other activity that caused
a substantial increase in breathing or heart rate for at least
20 min/day on 3 days/week. Subjects were assigned to the ‘less
active’ group if they exercised regularly but at levels that were
less than sufficient.
Abdominal obesity
WC was adopted as a variable for measuring obesity in this
analysis. While the effects of obesity on the risk of CHD are
commonly evaluated using body mass index (BMI),14
increasing evidence indicates that abdominal obesity, as
estimated by WC, represents a better marker of risk of CHD
than BMI.15e17 In a study among East Asians,18 abdominal
obesity was defined as having a large WC (90 cm for men,
80 cm for women). However, a higher cut-off for Korean
women was recommended from a study investigating the
relationship between WC and risk of CHD19; WC cut-offs of
90 cm for men and 85 cm for women were used in the present
study.
Risk of CHD
The Framingham Risk Score (FRS) was used to predict the 10-
year risk of CHD. The FRS is recognized as an important clin-
ical tool for assessing absolute risk of CHD, and uses an algo-
rithm that takes into account the following factors: age, gender,
total cholesterol, HDL cholesterol, blood pressure, diabetes
status and smoking status.18 The FRS was calculated separately
for men and women aged 30e74 years and without overt CHD. A
higher FRS reflects a greater 10-year risk of developing CHD; that
is, very low risk <6%, low risk 6e<10%, intermediate risk
10e<20%, and high risk 20%.7,20 In this paper, the high-risk
group was defined as 10-year risk of CHD 10%.
Analysis
After analysing the sample characteristics, the study sample
was categorized using WC and the level of physical activity.
WC <90 cm for men and WC <85 cm for women were cate-
gorized as normal, and WC 90 cm for men and WC 85 cm
were categorized as large. Likewise, the participants were
categorized as physically active (moderate physical activity
for at least 30 min/day on at least 5 days/week or vigorous
physical activity for at least 20 min/day on at least 3 days/
week), less active (exercise regularly but less than the sug-
gested levels above) or inactive (no regular exercise). Analysis
of variance was performed to test the relationship between
WC and physical activity for men and women. In addition,
hierarchical log linear analysis was used to test interactions
between sex, WC and physical activity. In order to examine
the relationship between abdominal obesity and physical
activity in association with high risk of CHD (10-year risk
10%) and the patterning of the relationship by sex, logistic
regression models were fitted by obesity and level of physical
activity, separately for men and women, and the odds ratios
(ORs) for high risk of CHD were estimated with 95% confidence
intervals (CIs). For logistic models, abdominal obesity was
examined both as a categorical variable (normal vs large) and
a continuous variable [per 1 standard deviation (SD)] for its
412 p u b l i c h e a l t h 1 2 6 ( 2 0 1 2 ) 4 1 0 e4 1 6

association with risk of CHD within each physical activity
category in men and women. The multivariate analysis
included education, marital status, household income,
household size and alcohol consumption as covariates.
P < 0.05 was considered to indicate statistical significance.
All statistical analyses were performed using Statistical
Package for the Social Sciences Version 17.0 (SPSS Inc.,
Chicago, IL, USA).
Results
Characteristics of the Korean national sample are presented
in Table 1. The average age of the sample was 50 years, and
59% were women. There was no difference in the age distri-
bution between men and women. The proportion of highly
educated (some college) subjects was lower among women
than among men. Most subjects were married, and the
average monthly household income was $2037. Sixty-three
percent of Korean men and 25% of women reported
consuming alcohol biweekly or more frequently. The mean
WC was 85.1 cm in men and 81.9 cm in women. The overall
characteristics of various risk factors of CHD were generally
unfavourable among men; this gender-related difference was
significant for HDL cholesterol, blood pressure, smoking
status and diabetic status. The proportion of subjects who
were physically active was higher among men (26%) than
among women (20%), whereas the proportion of physical
inactivity among women (61%) was higher than among men
(46%). The majority of Korean women (75%) and more than
half of Korean men (52%) had a 10-year FRS for low risk of CHD
(<10%), and 47.8% of men and 25.5% of women were at high
risk of CHD (10%).
Gender-specific analysis for risk factors of CHD (i.e. the
level of physical activity according to abdominal obesity) is
presented in Table 2. Cholesterol, HDL cholesterol, blood
pressure, hypertensive status, fasting blood sugar and dia-
betes status were unfavourable among men and women with
large WCs. Among women, older and sedentary women had
larger WCs.
The interactions between WC and physical activity are
presented separately for men and women in Table 3. Less
active women had lower WCs than active or inactive women
(F ¼ 3.640, P ¼ 0.027).

Table 1 e Characteristics of the sample (n [ 2112).

Men (n ¼ 867) n (%), Women (n ¼ 1245) n (%), c2/t P
mean (SD) mean (SD)

Age (years) 50.9 (12.7) 49.9 (12.9) 1.771 0.077

30e44 315 (36.3) 495 (39.8) 2.701 0.259
45e64 374 (43.1) 516 (41.4)
65e74 178 (20.5) 234 (18.8)
Household income ($/month) 2000.8 (1536.8) 2090.2 (1550.8) 1.311 0.190
Household size (no. of people) 3.5 (1.3) 3.4 (1.3) 0.293 0.769
Waist circumference (cm) 85.1 (8.1) 81.9 (9.6) 10.901 <0.001
Total cholesterol (mmol/l) 4.9 (0.9) 5.0 (1.0) 0.881 0.378
High-density lipoprotein cholesterol (mmol/l) 1.0 (0.3) 1.1 (0.3) 6.560 <0.001
Systolic blood pressure (mmHg) 121.0 (16.1) 114.9 (17.7) 8.271 <0.001
Diastolic blood pressure (mmHg) 79.6 (10.1) 74.0 (9.5) 13.101 <0.001
Fasting blood sugar (mmol/l) 2.6 (0.6) 2.5 (0.6) 3.399 0.001
Education
Middle school and under 302 (34.8) 588 (47.2) 45.348 <0.001
High school 290 (33.4) 404 (32.4)
Some college 275 (31.7) 253 (20.3)
Married 760 (87.7) 991 (79.6) 23.430 <0.001
Alcohol
Never been a drinker 141 (16.3) 507 (40.7) 320.900 <0.001
Monthly or less 179 (20.6) 431 (34.6)
Biweekly or more 547 (63.1) 307 (24.7)
Hypertensiona 148 (17.1) 228 (18.3) 0.540 0.463
Current smoker 371 (42.8) 51 (4.1) 478.619 <0.001
Diabetesb 111 (12.8) 104 (8.4) 11.065 0.001
Physical activity
Active 226 (26.1) 245 (19.7) 49.118 <0.001
Less active 241 (27.8) 235 (18.9)
Inactive 400 (46.1) 765 (61.4)
Framingham Risk Score
Very low (<6%) 270 (31.1) 742 (59.6) 203.385 <0.001
Low (6%e<10%) 183 (21.1) 186 (14.9)
Intermediate (10%e<20%) 254 (29.3) 256 (20.6)
High (20%) 160 (18.5) 61 (4.9)

SD, standard deviation.

a Hypertension: any respondent taking antihypertensive medication or a person with blood pressure 140 and/or 90 mmHg.
b Diabetes: any respondent taking antidiabetic drug, insulin injection or with fasting blood sugar 3.3 mmol/l.
 p u b l i c h e a l t h 1 2 6 ( 2 0 1 2 ) 4 1 0 e4 1 6 413

Table 2 e Risk factors for coronary heart disease: level of physical activity according to abdominal obesity (n [ 2112).
Normal waist Large waist c2/t P
circumferencea circumferencea
(n ¼ 1468) (n ¼ 644)

Men
Age (years) 50.9 (12.8) 50.8 (12.4) 0.169 0.866
Cholesterol (mmol/l) 4.9 (0.9) 5.0 (0.8) 2.280 0.023
High-density lipoprotein cholesterol (mmol/l) 1.1 (0.3) 0.9 (0.2) 9.800 <0.001
Systolic blood pressure (mmHg) 119.8 (16.3) 124.2 (15.2) 3.593 <0.001
Diastolic blood pressure (mmHg) 78.4 (9.6) 82.7 (10.7) 5.413 <0.001
Hypertension, n (%) 102 (16.3) 67 (27.9) 15.008 <0.001
Current smoke, n (%) 268 (42.7) 103 (42.9) 0.002 0.963
Fasting blood sugar (mmol/l) 2.5 (0.6) 2.7 (0.7) 3.137 0.002
Diabetes, n (%) 39 (6.2) 28 (11.7) 7.221 <0.001
Physical activity, n (%)
Active 155 (24.7) 71 (18.9) 3.516 0.172
Less active 171 (27.3) 70 (29.2)
Inactive 301 (48.0) 99 (41.3)
Women
Age (years) 46.9 (12.2) 56.1 (12.0) 12.578 <0.001
Cholesterol (mmol/l) 4.8 (0.9) 5.2 (1.0) 6.886 <0.001
High-density lipoprotein cholesterol (mmol/l) 1.1 (0.3) 1.1 (0.2) 6.164 <0.001
Systolic blood pressure (mmHg) 110.8 (16.0) 123.4 (18.0) 11.932 <0.001
Diastolic blood pressure (mmHg) 72.3 (9.1) 77.4 (9.3) 9.113 <0.001
Hypertension, n (%) 63 (7.5) 79 (19.6) 39.303 <0.001
Current smoke, n (%) 30 (3.7) 20 (5.0) 1.111 0.292
Fasting blood sugar (mmol/l) 2.4 (0.4) 2.7 (0.8) 7.620 <0.001
Diabetes, n (%) 20 (2.4) 50 (12.4) 51.410 <0.001
Physical activity, n (%)
Active 159 (18.9) 86 (21.3) 3.516 0.172
Less active 168 (20.0) 67 (16.6)
Inactive 514 (61.1) 251 (62.1)

Data are presented as mean (standard deviation) or n (%).

a Normal waist circumference (<90 cm for men and <85 cm for women), large waist circumference (90 cm for men and 85 cm for women).

Inter-relationships between sex, WC and physical activity
were identified in the hierarchical log linear model. Table 4
lists inter-relationships between the parameters. Sex was
significantly associated with WC and physical activity.
However, WC and physical activity were not associated with
each other.
Table 5 shows the ORs of high risk of CHD (10% risk for 10-
year CHD) among men and women on the basis of level of
physical activity and WC, before and after adjusting for
covariates. In addition, the ORs of high risk of CHD for a 1-SD
increase in WC by level of physical activity are presented. The
SD for WC was 8.1 for men and 9.6 for women. A large WC was
significantly associated with high risk of CHD for both Korean
men and women, regardless of their level of physical activity.
Compared with active men with a normal WC, less active or
inactive Korean men with a large WC had adjusted ORs of 3.57
(95% CI 1.89e6.76) and 2.91 (95% CI 1.63e5.22), respectively.
Even among active men, a large WC was associated with
increased risk of 10-year risk of CHD with an adjusted OR of
2.17 (95% CI 1.16e4.06). For men with a normal WC, the level of
physical activity was not associated with an increased OR
for CHD.
Compared with active women with a normal WC, inactive
women with a large WC had an adjusted OR of 6.37 (95% CI
3.44e11.80) for 10-year risk of CHD. Likewise, obese Korean
women who were less active were 4.59 times more likely to be
at high risk of CHD than their counterparts with normal WCs
(95% CI 2.11e9.99). A large WC was associated with an

Table 3 e Waist circumferences according to the level of physical activity (n [ 2112).

Active Less active Inactive F P
(n ¼ 471) (n ¼ 476) (n ¼ 1165)
mean (SD) mean (SD) mean (SD)

Waist circumference (cm)

Men 85.7 (7.7) 85.3 (8.1) 84.7 (8.3) 1.221 0.295
Women 81.8 (9.2)a 79.5 (9.3)b 81.0 (9.6)a 3.640 0.027

SD, standard deviation.

Duncan grouping: a > b.
414 p u b l i c h e a l t h 1 2 6 ( 2 0 1 2 ) 4 1 0 e4 1 6

associated with physical inactivity and abdominal obesity was

Table 4 e Inter-relationships between sex, waist
circumference and physical activity.
Interaction c2
a
Sex  waist circumference 5.886
Sex  physical activity 49.128
Waist circumferencea  physical activity 2.911
Sex  waist circumferencea  physical activity 3.125
a Normal waist circumference (<90 cm for men and <85 cm for
women), large waist circumference (90 cm for men and 85 cm
for women).
adjusted OR of 3.42 (95% CI 1.64e7.14) for active Korean
women. Among individuals with a normal WC, inactive
Korean women were at increased 10-year risk of CHD
compared with active Korean women (adjusted OR 2.16, 95%
CI 1.19e3.93). Less active women with a normal WC had
slightly increased odds of developing CHD, but the OR was not
significant. A 1-SD increase in WC was significantly associated
with the risk of CHD for both men and women. However, the
association was stronger for women regardless of the level of
physical activity.
Discussion
This analysis revealed a significant association between
physical activity, WC and risk of CHD in this Korean pop-
ulation sample. In particular, the 10-year risk of CHD
much stronger in Korean women than in Korean men (> 6
times vs about 3 times higher risk). This finding is consistent
P
with the results of previous population-based prospective
0.015 studies conducted in the UK and the USA, where inactive
<0.001 women with a large WC also had a greater risk of CHD than
0.233
inactive men with a large WC.7e9 Although such sex-specific
0.210
differences in the association between physical activity,
abdominal obesity and risk of CHD have rarely been studied,
a recent caseecontrol study found that the effect of physical
inactivity and abdominal obesity on inflammatory markers
associated with an increased risk of CHD was more
pronounced in women than in men.21 Together, these findings
underscore the importance of obesity control and physical
activity, especially among women.
Whilst regular physical activity has been found to provide
some protection against CHD among individuals with
a normal WC,7 the level of physical activity was not associated
with the risk of CHD in Korean men with a normal WC.
However, for Korean women with a normal WC, a sedentary
lifestyle resulted in increased risk of CHD. It is unclear why the
protective effect of physical activity was only seen among
women. One possible explanation may be that Korean women
(but not Korean men) with a normal WC were significantly
younger than those with a large WC (mean age 47 vs 56 years,
P < 0.001). Future studies are needed to investigate this rela-
tionship further.
The independent effects of obesity are well documented.
Both Korean men and women with large WCs were at
increased risk of CHD regardless of their level of physical

Table 5 e Odds ratios for high 10-year risk of coronary heart disease by physical activity and waist circumference for
Korean men and women in Korea National Health and Nutrition Examination Survey (KNHANES IVe1) in 2007 (n [ 2114).
Active Less active Inactive

OR 95% CI OR 95% CI OR 95% CI

Men (n ¼ 867)
Normal waist circumferencea
Unadjusted 1.00 e 0.77 (0.49e1.21) 1.41 (0.95e2.09)
Adjusted 1.00 e 1.02 (0.62e1.69) 1.38 (0.89e2.13)
Large waist circumferencea
Unadjusted 1.78 (1.01e3.14)* 2.06 (1.16e3.66)* 2.67 (1.58e4.50)***
Adjusted 2.17 (1.16e4.06)* 3.57 (1.89e6.76)*** 2.91 (1.63e5.22)***
Waist circumference for a 1-SD increase
Unadjusted 1.24 (0.92e1.68) 1.52 (1.12e2.04)** 1.50 (1.20e1.87)***
Adjusted 1.30 (1.05e1.62)* 1.41 (1.15e1.72)** 1.32 (1.13e1.54)**

Women (n ¼ 1245)
Normal waist circumferencea
Unadjusted 1.00 e 0.82 (0.40e1.68) 1.82 (1.06e3.12)*
Adjusted 1.00 e 1.49 (0.68e3.27) 2.16 (1.19e3.93)*
Large waist circumferencea
Unadjusted 4.20 (2.17e8.13)*** 6.75 (3.40e13.40)*** 7.77 (4.49e13.46)***
Adjusted 3.42 (1.64e7.14)** 4.59 (2.11e9.99)*** 6.37 (3.44e11.80)***
Waist circumference for a 1-SD increase
Unadjusted 1.97 (1.41e2.75)*** 2.69 (1.86e3.87)*** 2.08 (1.76e2.46)***
Adjusted 2.24 (1.55e3.23)*** 1.71 (1.24e2.34)** 1.55 (1.35e1.79)***

OR, odds ratio; CI, confidence interval; SD, standard deviation. ORs adjusted for education, marital status, household income, household size
and alcohol use.
*P < 0.05, **P < 0.01, ***P < 0.001.
a Normal waist circumference (<90 cm for men and <85 cm for women), large waist circumference (90 cm for men and 85 cm for women).
 p u b l i c h e a l t h 1 2 6 ( 2 0 1 2 ) 4 1 0 e4 1 6
activity. This finding is consistent with a recent Korean study
in which abdominal obesity was associated with a higher risk
of CHD,19 and also highlights the strong effect of abdominal
obesity as an important cardiovascular risk factor. Even in
women with a normal body weight, WC was correlated with
a heightened risk of CHD.22 In addition, other risk factors for
CHD, such as cholesterol, HDL cholesterol, blood pressure,
blood glucose level and smoking status, were unfavourable
when the individual had a large WC. These results highlight
the importance of incorporating more targeted abdominal
obesity prevention and control efforts in future lifestyle
interventions (e.g. nutritional counselling) for Koreans.
The present study has some limitations that should be
considered. The study was cross-sectional; it was therefore
impossible to establish cause-and-effect relationships
between physical activity, WC and risk of CHD. The physical
activity data were self-reported and restricted to the previous
week. Nevertheless, studies have shown that the self-report
physical activity questionnaire used in the study is valid and
reliable for the Korean population.23 The present study was
conducted on a nationwide basis; both physical inactivity and
abdominal obesity were found to affect the risk of CHD among
the Korean cohort. Future studies are needed to investigate
various types of physical activity, such as walking or occu-
pational activities.20
In conclusion, the 10-year risk of CHD in the Korean national
sample was significantly higher among those with a large WC
than in those with a normal WC. However, being physically
active did not eliminate the higher risk of CHD among Korean
men and women with abdominal obesity. These findings
confirm the importance of both physical activity and obesity
control among Koreans in order to reduce the overall risk of
CHD. Korean women, in particular, should be encouraged to
engage in physical activity and to maintain a normal WC.
Acknowledgements
Ethical approval
The Ethics Committee at the Korean Centers for Disease
Control and Prevention reviewed and approved the national
survey.
Funding
This research was supported by the Gachon University
Research Fund in 2011 (KWU-2011-R100).
Competing interests
None declared.
references
1. Lee IM, Sesso HD, Paffenbarger Jr RS. Physical activity and
coronary heart disease risk in men: does the duration of
exercise episodes predict risk? Circulation 2000;29:981e6.
415
2. Tanasescu M, Leitzmann MF, Rimm EB, Willett WC,
Stampfer MJ, Hu FB. Exercise type and intensity in relation
to coronary heart disease in men. JAMA
2002;288:1994e2000.
3. Apullan FJ, Bourassa MG, Tardif JC, Fortier A, Gayda M,
Nigam A. Usefulness of self-reported leisure-time physical
activity to predict long-term survival in patients with
coronary heart disease. Am J Cardiol 2008;15:375e9.
4. Ueshima K, Ishikawa-Takata K, Yorifuji T, Suzuki E,
Kashima S, Takao S, et al. Physical activity and mortality risk
in the Japanese elderly: a cohort study. Am J Prev Med
2010;38:410e8.
5. Moholdt T, Wisloff U, Nilsen TI, Slordahl SA. Physical activity
and mortality in men and women with coronary heart
disease: a prospective population-based cohort study in
Norway (the HUNT study). Eur J Cardiovasc Prev Rehabil
2008;15:639e45.
6. Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA,
Manson JE. Adiposity as compared with physical activity in
predicting mortality among women. N Engl J Med
2004;351:2694e703.
7. Arsenault BJ, Rana JS, Lemieux I, Despres JP, Kastelein JJ,
Boekholdt SM, et al. Physical inactivity, abdominal obesity
and risk of coronary heart disease in apparently healthy men
and women. Int J Obes 2010;34:340e7.
8. Wessel TR, Arant CB, Olson MB, Johnson BD, Reis SE,
Sharaf BL, et al. Relationship of physical fitness vs body mass
index with coronary artery disease and cardiovascular events
in women. JAMA 2004;292:1179e87.
9. Hu G, Tuomilehto J, Silventoinen K, Barengo N, Jousilahti P.
Joint effects of physical activity, body mass index, waist
circumference and waist-to-hip ratio with the risk of
cardiovascular disease among middle-aged Finnish men and
women. Eur Heart J 2004;25:2212e9.
10. Khor GL. Cardiovascular epidemiology in the Asia-Pacific
region. Asia Pac J Clin Nutr 2001;10:76e80.
11. Statistics Korea. Cause of death statistics. Available at: http://
kosis.kr/abroad/abroad_01List.jsp [last accessed 14.07.10].
12. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML,
Ainsworth BE, et al. International physical activity
questionnaire: 12-country reliability and validity. Med Sci
Sports Exerc 2003;35:1381e95.
13. Han MA, Kim KS, Park J, Kang MG, Ryu SY. Association
between levels of physical activity and poor self-rated health
in Korean adults: the third Korea national health and
nutrition examination survey (KNHANES), 2005. Public Health
2009;123:665e9.
14. Weinstein AR, Sesso HD, Lee IM, Rexrode KM, Cook NR,
Manson JE, et al. The joint effects of physical activity and
body mass index on coronary heart disease risk in women.
Arch Intern Med 2008;168:884e90.
15. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG,
Commerford P, et al. Obesity and the risk of myocardial
infarction in 27,000 participants from 52 countries:
a caseecontrol study. Lancet 2005;366:1640e9.
16. Balkau B, Deanfield JE, Despres JP, Bassand JP, Fox KA,
Smith Jr SC, et al. International day for the evaluation of
abdominal obesity (IDEA): a study of waist circumference,
cardiovascular disease, and diabetes mellitus in 168,000
primary care patients in 63 countries. Circulation
2007;23:1942e51.
17. Mosca L, Edelman D, Mochari H, Christian AH, Paultre F,
Pollin I. Waist circumference predicts cardiometabolic and
global Framingham risk among women screened during
national woman’s heart day. J Womens Health
2006;15:24e34.
18. National Cholesterol Education Program (NCEP) Expert Panel
on Detection. Evaluation, and treatment of high blood
cholesterol in adults (adult treatment panel III). Third report
416 p u b l i c h e a l t h 1 2 6 ( 2 0 1 2 ) 4 1 0 e4 1 6
of the national cholesterol education program (NCEP) expert
panel on detection, evaluation, and treatment of high blood
cholesterol in adults (adult treatment panel III) final report.
Circulation 2002;106:3143e421.
19. Park SH, Choi SJ, Lee KS, Park HY. Waist circumference and
waist-to-height ratio as predictors of cardiovascular disease
risk in Korean adults. Circ J 2009;73:1643e50.
20. Hu G, Tuomilehto J, Borodulin K, Jousilahti P. The joint
associations of occupational, commuting, and leisure-time
physical activity, and the Framingham risk score on the 10-
year risk of coronary heart disease. Eur Heart J
2007;28:492e8.
21. Rana JS, Arsenault BJ, Després JP, Côté M, Talmud PJ, Ninio E,
et al. Inflammatory biomarkers, physical activity, waist
circumference, and risk of future coronary heart disease in
healthy men and women. Eur Heart J; 2009 [e-pub ahead of
print 18 February 2009].
22. Kwon S. Association between abdominal obesity and
cardiovascular risk factors in normal-weight Korean women.
Health Care Women Int 2009;30:447e52.
23. Lee DT, Seo YS, Son YS, Moon EM, Jin YJ. Estimation of
physical activity levels using international physical activity
questionnaire (IPAQ) and its reliability for overweight middle
aged women. J Korean Soc Living Environ Sys 2007;14:1e8.