This meta-analysis aimed to study the relationship between abdominal obesity and the risk of cardiovascular disease (CVD) by waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). We systematically searched PubMed, Embase and Web of Science. Prospective studies that estimated cardiovascular events by WC, WHR and WHtR were included in this study. Pooled relative risks with 95% confidence intervals were calculated using random-effects models. A total of 31 studies were included in the meta-analysis, including 669,560 participants and 25,214 cases. Compared the highest with the lowest category of WC, WHR and WHtR, the summary RRs were 1.43 (95% CI, 1.30-1.56, P < 0.001), 1.43 (95% CI, 1.33-1.54, P < 0.001) and 1.57 (95% CI, 1.37-1.79, P < 0.001), respectively. The linear dose-response analysis revealed that the risk of CVD increased by 3.4% for each 10 cm increase of WC, 3.5% and 6.0% for each 0.1 unit increase of WHR and WHtR in women. In men, the risk of CVD increased by 4.0% for each 10 cm increase of WC, 4.0% and 8.6% for each 0.1 unit increase of WHR and WHtR, respectively. Collectively, abdominal obesity is associated with an increased risk of CVD. WC, WHR and WHtR are good indicators for the prediction of CVD.
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