Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type-2 diabetes: a prospective cohort study from ADVANCE
Why the study?
Do waist-to-hip ratio and waist circumference better predict cardiovascular disease risk compared to body mass index in patients with type-2 diabetes?
Population
11,140 men and women with type-2 diabetes
Comparison
Waist-to-hip ratio, waist circumference, and… vs Comparison among WHR, WC, and BMI
Design
Cohort
Follow-up
mean 4.8 years
Authors
Discussion
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Member takes
Implication
WHR may better stratify CV risk than BMI in T2D; hypothesis-generating and should not yet change practice.
Key Points
- To compare the strength of associations and discrimination performance of body mass index, waist circumference, and waist-to-hip ratio for cardiovascular disease risk in patients with type-2 diabetes.
- Conducted a prospective cohort analysis of 11,140 men and women with type-2 diabetes followed for a mean of 4.8 years.
- Used Cox proportional hazard models to determine hazard ratios per one standard deviation increase in baseline body mass index (5 kg/m²), waist circumference (13 cm), and waist-to-hip ratio (0.08).
- Waist-to-hip ratio showed significant associations with cardiovascular events (HR 1.12, 95% CI 1.05–1.19), coronary events (HR 1.17, 95% CI 1.08–1.28), and cardiovascular deaths (HR 1.19, 95% CI 1.09–1.31).
- Waist circumference showed modest associations (cardiovascular events HR 1.10, 95% CI 1.03–1.18; coronary events HR 1.13, 95% CI 1.03–1.24; cardiovascular deaths HR 1.08, 95% CI 0.98–1.19), while body mass index showed no association with any outcome.
- Relative integrated discrimination improvement confirmed enhanced discrimination for waist-to-hip ratio across cardiovascular outcomes, even though receiver operating characteristic curves did not differentiate variables (P=0.24).
Structured PICO
Do waist-to-hip ratio and waist circumference better predict cardiovascular disease risk compared to body mass index in patients with type-2 diabetes?
P
Population
11,140 men and women with type-2 diabetes
I
Intervention
Waist-to-hip ratio (WHR), waist circumference (WC), and body mass index (BMI) as predictors
C
Comparator
Comparison among WHR, WC, and BMI
O
Outcome
Cardiovascular events, coronary events, and cardiovascular deathshard clinical
Waist-to-hip ratio is a better predictor of cardiovascular events and mortality than body mass index in patients with type-2 diabetes.
Cite This Study
Czernichow et al. (2010) studied this question.