Key result
Waist-to-BMI ratio was significantly associated with an increased risk of major adverse cardiovascular events in patients with established atherosclerotic cardiovascular disease (HR 1.69 per cm‧m2/kg increase).
Why the study?
An obesity paradox is observed in CAD when defining obesity by BMI, prompting the search for a better anthropometric parameter to predict cardiovascular events in ASCVD.
Does waist-to-BMI ratio predict composite MACE in adult patients with stable ASCVD?
Observational (n=6,920)
Yes
Does waist-to-BMI ratio predict composite MACE in adult patients with stable ASCVD?
Hazard Ratio: 1.69 (95% CI 1.12–2.49)
p-value: p=0.01
The waist-to-BMI ratio is a significant positive predictor for the risk of major adverse cardiovascular events in patients with established ASCVD, outperforming traditional anthropometric parameters.
Waist-to-BMI ratio was associated with higher MACE risk in stable ASCVD; leaves open incremental value for risk stratification.
Obesity is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, ‘obesity paradox’ is observed in patients with coronary artery disease while defining obesity by body mass index (BMI). The purpose of this study is to identify a better anthropometric parameter to predict cardiovascular events in patients with ASCVD. The study was conducted using the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. A total of 6,920 adult patients with stable ASCVD, enrolled from January 2010 to November 2014, were included, with a mean age of 65.9 years, 73.9% males, and a mean BMI of 26.3 kg/m2 at baseline. These patients were followed up for a median of 2.5 years. The study endpoint was the composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Multivariable Cox proportional hazards regression showed a significant positive association between waist-to-BMI ratio and MACE (adjusted hazard ratio 1.69 per cm‧m2/kg increase in waist-to-BMI ratio, 95% CI 1.12–2.49, p = 0.01) after adjusting for potential risk factors and confounders. Traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, or newer waist-based indices, such as body roundness index and a body shape index, did not show any significant linear associations (p = 0.09, 0.30, 0.89, 0.54, 0.79 and 0.06, respectively). In the restricted cubic spline regression analysis, the positive dose–response association between waist-to-BMI ratio and MACE persisted across all the range of waist-to-BMI ratio. The positive dose–response association was non-linear with a much steeper increase in the risk of MACE for waist-to-BMI ratio > 3.6 cm‧m2/kg. In conclusion, waist-to-BMI ratio may function as a positive predictor for the risk of MACE in established ASCVD patients.
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Hsuan et al. (2022) conducted an observational in Atherosclerotic cardiovascular disease (ASCVD) (n=6,920). Waist-to-BMI ratio vs. Lower waist-to-BMI ratio was evaluated on Composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation (HR 1.69, 95% CI 1.12-2.49, p=0.01). Waist-to-BMI ratio was significantly associated with an increased risk of major adverse cardiovascular events in patients with established atherosclerotic cardiovascular disease (HR 1.69 per cm‧m2/kg increase).
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