Indices of abdominal obesity more predictive of coronary heart disease than body mass index
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Body mass index (BMI) is often used as surrogate for total adiposity, while fat distribution is transversally associated with cardiovascular risk. The prospective relation between body fat distribution and coronary heart disease was investigated among 24508 subjects of both sexes, aged 45 to 79 years, during a mean 9.1 years of follow-up. Proportional hazards regression analysis revealed that the risk of developing coronary heart disease increased continuously across the range of waist-hip ratio. After adjusting for BMI and standard coronary heart disease risk factors, hazard ratios of the top versus bottom fifth of waist-to-hip ratio were 1.55 in men and 1.91 in women. Hazard ratios increased with waist circumference but without adjusting for hip circumference, risk estimates for waist circumference were attenuated by 10% to 18%. When adjusting for waist circumference, BMI, and coronary heart disease risk factors, hazard ratios for an increase of one standard deviation in hip circumference were 0.80 in both sexes. After adjusting for waist-to-hip ratio or waist circumference, hazard ratios for BMI were greatly lowered. Based on these results, the authors conclude that indices of abdominal obesity were more consistently predictive of coronary heart disease than BMI.
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