Abdominal Adiposity and Coronary Heart Disease in Women

Abstract

Context.-Obesity is a well-established risk factor for coronary heart disease (CHD), but whether regional fat distribution contributes independently to risk remains unclear. Objective.-To compare waist-hip ratio (WHR) and waist circumference in determining risk of CHD in women. Design and Setting.-Prospective cohort study among US female registered nurses participating in the Nurses' Health Study conducted between 1986, when the nurses completed a questionnaire, and follow-up in June 1994. Participants.-A total of 44 702 women aged 40 to 65 years who provided waist and hip circumferences and were free of prior CHD, stroke, or cancer in 1986. Main Outcome Measures.-Incidence of CHD (nonfatal myocardial infarction or CHD death). Results.-During 8 years of follow-up 320 CHD events (251 myocardial infarctions and 69 CHD deaths) were documented. Higher WHR and greater waist circumference were independently associated with a significantly increased ageadjusted risk of CHD. After adjusting for body mass index (BMI) (defined as weight in kilograms divided by the square of height in meters) and other cardiac risk factors, women with a WHR of 0.88 or higher had a relative risk (RR) of 3.25 (95% confidence interval [CI], 1.78-5.95) for CHD compared with women with a WHR of less than 0.72. A waist circumference of 96.5 cm (38 in) or more was associated with an RR of 3.06 (95% CI, 1.54-6.10). The WHR and waist circumference were independently strongly associated with increased risk of CHD also among women with a BMI of 25 kg/m 2 or less. After adjustment for reported hypertension, diabetes, and high cholesterol level, a WHR of 0.76 or higher or waist circumference of 76.2 cm (30 in) or more was associated with more than a 2-fold higher risk of CHD. Conclusions.-The WHR and waist circumference are independently associated with risk of CHD in women.

Targeting abdominal obesity in cardiology: Can we be effective?

“…Only women whose WC was less than 88 cm had a decreased risk of mortality with increasing BMI (42). In the Nurses' Health Study (43), WHR and WC were independently strongly associated with increased risk of coronary artery disease among women with a BMI of 25 kg/m 2 or less, and in the Paris Prospective Study (44), sagittal diameter (ie, abdominal obesity) was the only significant predictor of cardiac death. In patients with known CVD or following acute myocardial infarction, overall obesity as assessed by BMI was not associated with cardiovascular mortality, myocardial infarction and total mortality when abdominal obesity indexes (WHR and WC) were integrated into the statistical analysis (12,45,46).…”

Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people

“…Among the four variables, WC was the first variable entering the model. (Rexrode et al, 1998;Dey et al, 2002). To compare the relative importance of four anthropometric measurements, we took those measurements as categorical and continuous variables to estimate RRs, population attributable risk and likelihood ratio statistics.…”

“…Body mass index (BMI) is perhaps the most commonly used measurement. Waist-to-hip ratio has been reported as a better predictor of coronary heart disease than BMI (Rimm et al, 1995;Rexrode et al, 1998). However, waist-to-hip ratio is considered an artificial term with no biological meaning, and it does not usefully reflect fat distribution or health better than waist circumference (WC) alone (Lean & Han, 2002).…”

“…However, waist-to-hip ratio is considered an artificial term with no biological meaning, and it does not usefully reflect fat distribution or health better than waist circumference (WC) alone (Lean & Han, 2002). Several studies have shown that WC is more closely associated with visceral adipose tissue mass, than is either waist-to-hip ratio or BMI (van der Kooy & Seidell, 1993;Pouliot et al, 1994), and that WC is independently associated with increased risk of coronary heart disease (Rimm et al, 1995;Rexrode et al, 1998;Iwao et al, 2001) and stroke (Dey et al, 2002). Seidell et al (2001) suggest that people with a narrow WC and a large hip circumference have a lower risk of cardiovascular disease.…”

Spatial distribution of the risk for metabolic complications: an application in south-east Brazil, 2006–2007

“…This combined risk, called 'risk for metabolic complications' (RMC) herein, was defined according to the National Institutes of Health (26,(29)(30)(31) as shown in Table 1.…”