April 14, 2026Diabetes Care
Waist-to-Height Ratio Is Associated With the Risk of Coronary Artery Disease in Type 1 Diabetes: A 19-Year Cohort Study
Key result
Higher waist-to-height ratio linked to ~21% greater CAD risk per 0.1-unit increase in T1D.
- HR 1.21
- 95% CI 1.06-1.38
- P=0.006
- n=4,349
Diabetes Care published a graphical abstract
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Why the study?
Obesity, kidney disease, and CAD are interconnected, prompting investigation into the relationship between central obesity and CAD across albuminuria categories in type 1 diabetes.
Is central obesity (waist-to-height ratio ≥0.5) associated with an increased risk of coronary artery disease in individuals with type 1 diabetes?
Key Points
- This research aims to investigate the link between waist-to-height ratio and coronary artery disease risk in individuals with type 1 diabetes.
- Analyzed data from 4,349 individuals without prior coronary artery disease over 19 years.
- Defined central obesity based on a waist-to-height ratio of ≥0.5.
- Used Cox regression to assess associations with baseline covariates.
- Observed 664 CAD events (15.3%) during the follow-up period.
- 10-year cumulative CAD incidence was 11.6% for those with central obesity, compared to 4.4% without.
- The hazard ratio for CAD increased by 1.21 per 0.1-unit increase in WHtR overall, and 1.26 among those without albuminuria.
Study Design
Type
Cohort (n=4,349)
Structured PICO
Is central obesity (waist-to-height ratio ≥0.5) associated with an increased risk of coronary artery disease in individuals with type 1 diabetes?
P
Population
4,349 individuals with type 1 diabetes without prior coronary artery disease from the Finnish Diabetic Nephropathy Study
I
Intervention
Central obesity (defined as waist-to-height ratio [WHtR] ≥0.5)
C
Comparator
No central obesity (WHtR <0.5)
O
Outcome
Composite of acute myocardial infarction, coronary revascularizations, and CAD-related deathcomposite
Main Result
Effect estimate: HR 1.21 (95% CI 1.06-1.38)
Absolute Event Rate: 25.3% vs 9.9%
p-value: p=0.006
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“As long as they have accumulation of fat in the center of body and they can develop this low-grade inflammation that also goes to insulin-load sensitivity, people with T1DM can accumulate fat in the liver as do people with T2DM and the general population.”
Implication
Waist-to-height ratio is a significant predictor of coronary artery disease risk in patients with type 1 diabetes, particularly among those without albuminuria.
Abstract
Obesity, kidney disease, and coronary artery disease (CAD) are interconnected. Here, the relationship between central obesity and CAD across albuminuria categories in type 1 diabetes was investigated. Data on 4,349 individuals without prior CAD from the Finnish Diabetic Nephropathy Study were analyzed. Central obesity was defined as waist-to-height ratio (WHtR) ≥0.5. Outcomes included acute myocardial infarction, coronary revascularizations, and CAD-related death. Associations were assessed with Cox regression adjusted for baseline covariates. Over a median 19-year follow-up, 664 CAD events (15.3%) occurred. The 10- and 20-year cumulative CAD incidences were 11.6% and 25.3%, respectively, in those with central obesity versus 4.4% and 9.9% without, respectively. In multivariable analysis, the hazard ratio for CAD per 0.1-unit WHtR increase was 1.21 (95% CI, 1.06–1.38); P = 0.006) overall and 1.26 (95% CI, 1.02–1.56; P = 0.03) among those without albuminuria. In conclusion, WHtR is associated with increased CAD risk in type 1 diabetes, particularly among those without albuminuria.
Cite This Study
Parente et al. (2026) conducted a cohort in Type 1 diabetes (n=4,349). Central obesity (waist-to-height ratio ≥0.5) vs. Without central obesity was evaluated on Acute myocardial infarction, coronary revascularizations, and CAD-related death (HR 1.21, 95% CI 1.06-1.38, p=0.006). A 0.1-unit increase in waist-to-height ratio was associated with a higher risk of coronary artery disease in type 1 diabetes (HR 1.21; 95% CI 1.06-1.38; P=0.006).