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J Am Coll Cardiol 2007;50:752-9

Waist-to-Hip Ratio is a Superior Predictor of Atherosclerosis Compared with Body Mass Index in a Population-Based Sample: Observations from the Dallas Heart Study. J Am Coll Cardiol 2007;50:752-9.

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J Am Coll Cardiol 2007;50:752-9

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  1. Waist-to-Hip Ratio is a Superior Predictor of Atherosclerosis Compared with Body Mass Index in a Population-Based Sample: Observations from the Dallas Heart Study J Am Coll Cardiol 2007;50:752-9 Raphael See, Shuaib Abdullah, Darren K. McGuire, Amit Khera, Mahesh J. Patel, Jason B. Lindsey, Scott M. Grundy, James A. de Lemos

  2. Background • Obesity is associated with an increased risk of CV mortality • Most prior studies examining CV risk have used BMI as the measure of obesity • BMI poorly characterizes central obesity • Waist circumference (WC) and waist-to-hip ratio (WHR) more strongly correlate with CV event rates Rimm EB, et al., Am J Epidemiol 1995;141:1117-27; Dagenais GR, et al., Am Heart J 2005;149:54-60.; Yusuf S, et al., Lancet 2005;366:1640-9.

  3. Obesity & CV Events Yusuf S, et al. Lancet 2005;366:1640-9

  4. Obesity & Coronary Artery Calcification • Cassidy et al: 443 non-diabetic, aSx white men • BMI, WC, & WHR independently associated with CAC in low risk men • Snell-Bergeon et al: 762 aSx subjects • BMI & WC independently associated with CAC in men & women • WHR associated with CAC only in men • Study populations were small, homogeneous, and selected Cassidy AE, et al., Circulation 2005;111:1877-82; Snell-Bergeon JK, et al. Int J Obes Relat Metab Disord 2004;28:1594-9.

  5. Objective • Determine the association between differing measures of obesity and atherosclerosis

  6. Dallas Heart Study: Population-based probability sample of 6,101 subjects Measures of body composition: Body mass index Waist circumference Waist-to-hip ratio Hip circumference Visit 1 Detailed health survey n=6,101 Visit 2 Blood / urine collection n=3,398 Visit 3 Anthropometrics EBCT/MRI n=2,971 2,744 subjects ages 30-65 with interpretable scan data Methods

  7. Measures of Atherosclerosis Coronary Artery Calcification by CT Abdominal Aortic Plaque by MRI

  8. Statistical Analysis • Sex-specific quintiles for each obesity measurement • BMI, WC, and WHR • Logistic regression analyses • Univariable models • Dependent variable: CAC or aortic plaque • Independent variables: obesity measures in quintiles • Multivariable models • Dependent variable: CAC or aortic plaque • Independent variables: obesity measures in quintiles + traditional CV risk factors • C-statistic comparisons for above models

  9. Quintile Cut-points

  10. Association Between Obesity & CAC

  11. Association Between Obesity & Aortic Plaque

  12. Association Between Obesity & CAC after MV adjustment Adjusted for: age, smoking, DM, dyslipidemia, low HDL, high TG

  13. Association Between Obesity & Aortic Plaque after MV Adjustment Adjusted for: age, smoking, DM, dyslipidemia, low HDL, high TG

  14. C-statistics from Univariable Models * P < 0.01 vs BMI ± p < 0.01 vs WC

  15. C-statistics from MV Models

  16. Waist & Hip Circumference Analyses Women “large” waist “normal” waist Men p-values for WCxHC interaction: Women < 0.01 Men = 0.07

  17. Conclusions • WHR is more closely associated with atherosclerosis than other measures of obesity • Independent of traditional risk factors • Did not increment the c-statistic over CV risk factor model • Superiority of WHR may be due to an interaction between WC & HC • Associations between differing measures of obesity and atherosclerosis resemble those with CV events • Suggest atherosclerosis may be a link between obesity and events

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