Relation of Waist-Hip Ratio to Long-Term Cardiovascular Events in Patients With Coronary Artery Disease

Jose R. Medina-Inojosa, John A. Batsis, Marta Supervia, Virend Somers, Randal J. Thomas, Sarah Jenkins, Chassidy Grimes, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We aimed to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation for previous CAD events, who were classified using body mass index (BMI) groups and gender-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system. Major cardiovascular event (MACE) was defined as the composite outcome including acute coronary syndromes, coronary revascularization, ventricular arrhythmias, stroke, or death from any cause. We used Cox proportional hazards models adjusted for potential confounders. The cohort included 1,529 patients (74% men), 63.1 ± 12.5 years (mean age ± SD), of whom 40% were obese by BMI. Eighty-eight percent of men and 57% of women were classified as having central obesity by WHR. Median follow-up was 5.7 years and 415 patients had MACE. After adjustment, a high WHR tertile was a significant predictor for MACE in women (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.16, 2.94, p = 0.01) but not in men (HR 0.92, 95% CI 0.69, 1.22, p = 0.54). This relation in women persisted after further adjustment for BMI (HR 1.75, 95% CI 1.07, 2.87, p = 0.03). Obesity by BMI was not associated with MACE in either men (HR 1.07, 95% CI 0.76, 1.51, p = 0.69) or women (HR 0.98, 95% CI 0.62, 1.56, p = 0.95). In conclusion, WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI in patients with CAD when including nonfatal events.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Waist-Hip Ratio
Coronary Artery Disease
Body Mass Index
Confidence Intervals
Obesity
Abdominal Obesity
Acute Coronary Syndrome
Proportional Hazards Models
Cardiac Arrhythmias
Cause of Death
Stroke
Outcome Assessment (Health Care)
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation of Waist-Hip Ratio to Long-Term Cardiovascular Events in Patients With Coronary Artery Disease. / Medina-Inojosa, Jose R.; Batsis, John A.; Supervia, Marta; Somers, Virend; Thomas, Randal J.; Jenkins, Sarah; Grimes, Chassidy; Lopez-Jimenez, Francisco.

In: American Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Medina-Inojosa, Jose R. ; Batsis, John A. ; Supervia, Marta ; Somers, Virend ; Thomas, Randal J. ; Jenkins, Sarah ; Grimes, Chassidy ; Lopez-Jimenez, Francisco. / Relation of Waist-Hip Ratio to Long-Term Cardiovascular Events in Patients With Coronary Artery Disease. In: American Journal of Cardiology. 2018.
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abstract = "We aimed to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation for previous CAD events, who were classified using body mass index (BMI) groups and gender-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system. Major cardiovascular event (MACE) was defined as the composite outcome including acute coronary syndromes, coronary revascularization, ventricular arrhythmias, stroke, or death from any cause. We used Cox proportional hazards models adjusted for potential confounders. The cohort included 1,529 patients (74{\%} men), 63.1 ± 12.5 years (mean age ± SD), of whom 40{\%} were obese by BMI. Eighty-eight percent of men and 57{\%} of women were classified as having central obesity by WHR. Median follow-up was 5.7 years and 415 patients had MACE. After adjustment, a high WHR tertile was a significant predictor for MACE in women (hazard ratio [HR] 1.85, 95{\%} confidence interval [CI] 1.16, 2.94, p = 0.01) but not in men (HR 0.92, 95{\%} CI 0.69, 1.22, p = 0.54). This relation in women persisted after further adjustment for BMI (HR 1.75, 95{\%} CI 1.07, 2.87, p = 0.03). Obesity by BMI was not associated with MACE in either men (HR 1.07, 95{\%} CI 0.76, 1.51, p = 0.69) or women (HR 0.98, 95{\%} CI 0.62, 1.56, p = 0.95). In conclusion, WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI in patients with CAD when including nonfatal events.",
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