Cumulative WHtR burden increased MACE risk by 60% (HR=1.60) and outperformed BMI in cardiovascular risk prediction over 16 years in obese adults.
Does cumulative adiposity burden measured by waist-to-height ratio provide superior prediction of major adverse cardiovascular events compared to body mass index in obese individuals?
Cumulative adiposity burden measured by waist-to-height ratio provides superior cardiovascular risk discrimination compared to BMI, supporting its use in clinical obesity management.
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Abstract Background Obesity is a well-established, modifiable risk factor for cardiovascular diseases. The novel consensus of definition and diagnostic criteria of clinical obesity emphasises central obesity assessment using the waist-to-height ratio (WHtR) over traditional body mass index (BMI). While the cross-sectional associations between adiposity metrics and cardiovascular outcomes are well-documented, the longitudinal impact of cumulative adiposity burden quantified through WHtR and BMI remains unexplored. Purposes This study aims to compare the prognostic value of cumulative BMI and WHtR burden for major adverse cardiovascular events (MACE) and validate the 2025 consensus of clinical obesity recommendation favouring WHtR in cardiovascular risk stratification. Methods This longitudinal analysis utilised data from 2,679 the ARIC study participants (1987-1998) meeting obesity criteria (BMI ≥ 30 kg/m²) with complete serial anthropometric measurements. Cumulative adiposity burden was calculated as the area under the curve (AUC) for both BMI (kg/m²-years) and WHtR (unitless-years) using trapezoidal integration of biennial measurements. The primary outcome was incident MACE (myocardial infarction, ischemic stroke, or cardiovascular death) from 1998 to 2019. Pearson's correlation coefficient examined the relationship between BMI and WHtR. Cox proportional hazards models adjusted for baseline covariates (age, sex, race, systolic blood pressure, lipid profile, glycemic status, and comorbidities) evaluated quartiles of adiposity burden. Model discrimination was assessed using Harrell's C-statistic. Statistical analyses were performed using R (version 4.3.1). Results Participants (mean age 53.7±5.6 years; 59.4% male) demonstrated a strong positive correlation between cumulative BMI and WHtR burden (r = .83, P .001). Over a mean follow-up of 191.45 months, fully adjusted models revealed dose-response relationships: upper BMI quartiles showed 38% increased risk (Q3: HR = 1.38, 95% CI 1.07-1.76, P = .011) and 52% increased risk (Q4: HR = 1.52, 1.19-1.95, P .001), while WHtR Q4 demonstrated a 60% increased risk (HR = 1.60, 1.25-2.06, P .001). Survival curves demonstrated progressive risk stratification across burden quartiles, with the highest risk observed in the Q4 group for both BMI and WHtR (P .001) (Figure 1). WHtR burden exhibited superior predictive performance (0.57 vs. 0.56) and greater contribution to MACE risk (χ² = 33.28 vs. 22.64, P .01) compared to BMI (Figure 2). Conclusion Cumulative adiposity burden, measured as the total AUC for BMI and WHtR, is significantly associated with long-term MACE risk. The current study validates the emphasises on WHtR in novel consensus, demonstrating superior cardiovascular risk discrimination compared to BMI. These findings support integrating dynamic WHtR monitoring into obesity management protocols to enhance cardiovascular risk prediction.
Yang et al. (Sat,) reported a other. Cumulative WHtR burden increased MACE risk by 60% (HR=1.60) and outperformed BMI in cardiovascular risk prediction over 16 years in obese adults.