TOPLINE

Among individuals with normal weight, 5% had elevated waist circumference (WC) and 18% had high waist-to-hip ratio (WHR). Among individuals with obesity, a substantial proportion of certain cardiovascular disease (CVD) events occurred in those with high WC.

METHODOLOGY

• Researchers conducted a pooled analysis of data from 15 prospective cohorts to assess whether WC and WHR changed cardiovascular risk classification beyond BMI.
• A total of 260,861 participants without reported history of coronary heart disease (CHD) were included for WC analysis and 220,370 for WHR analysis. The sample had a mean age of about 61 years and was predominantly female.
• Participants were categorized by BMI (normal weight 18.5 to < 25.0, overweight 25.0 to < 30.0, obesity ≥ 30.0) and by sex-specific WC and WHR quartiles, with high WC defined as > 88 cm for women and > 102 cm for men, and high WHR as > 0.85 for women and > 0.90 for men.
• Researchers assessed nine adjudicated CV and mortality outcomes including myocardial infarction, stroke, and CVD mortality, over a median follow-up duration of 20 years.

TAKEAWAY

• Among individuals with normal weight, 5% had high WC and 18% had high WHR. Among those overweight, about 39% had high WC and 40% had high WHR; among those with obesity, 9% had low WC and 45% had low WHR.
• Individuals with normal weight who had high WC or high WHR experienced higher risk for most CV outcomes.
• Women with obesity and low WHR had significantly higher risk for all outcomes than those with normal weight and low WHR, although lower than those with high WHR and obesity. Men with obesity and low WHR generally did not differ significantly from men with normal weight and low WHR, except for atrial fibrillation.
• Population attributable fractions among individuals with obesity ranged from about 28.8% to 48.9% for high WC and 12.8% to 27% for high WHR, with the largest fractions for high WC seen for atrial fibrillation (48.9%) and heart failure (46.2%).

IN PRACTICE

"Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes. We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings," the authors of the study wrote.

SOURCE

The study was led by Zeina A. Dardari, PhD, MS, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease in Baltimore. It was published online on August 11 in the Journal of the American College of Cardiology.

LIMITATIONS

WC and WHR measurements were obtained at a single timepoint and may not reflect changes over time. The study was observational and may have included residual confounding and could not establish any cause-effect relationship. Researchers did not have measures of diet, physical activity, or genetic risk for obesity.

DISCLOSURES

The studies included in this analysis received support from multiple sources including the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the National Institute of Diabetes and Digestive and Kidney Diseases. One author reported serving on advisory boards for several pharmaceutical and healthcare companies. Detailed disclosures are available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.