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September 12, 2026Diabetology & Metabolic SyndromeOpen Access

Measures of obesity and first atherosclerotic cardiovascular events in stage 0 cardiovascular-kidney-metabolic syndrome: Tehran lipid and glucose study

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Key result

Higher waist circumference linked to ~59% greater ASCVD risk per 5 cm in CKM stage 0.

  • HR 1.59
  • 95% CI 1.28-1.98
  • P<0.001
  • n=691

Why the study?

To investigate the association between obesity measures and the risk of incident ASCVD among adults at CKM stage 0 in a Middle Eastern population.

Do higher obesity measures increase the risk of incident ASCVD in adults at cardiovascular-kidney-metabolic syndrome stage 0?

Population

691 adults free of CKM risk factors in the Tehran Lipid and Glucose Study

Comparison

Obesity measures (BMI, WC, WHtR, and WHR) vs incident ASCVD risk

Design

Prospective cohort study

Follow-up

Median of 19.6 years

Authors

SMSoroush MasrouriResearch Institute for Endocrine SciencesNENavid EbrahimiThe University of Texas at ArlingtonSZSeyed Saeed Tamehri ZadehGeneral / Preventive / Lipids

Discussion

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Implication

Abdominal obesity may refine ASCVD risk assessment in CKM stage 0; leaves open causal role and preventive interventions.

Key Points

  • To examine the association between various obesity measures and the risk of incident atherosclerotic cardiovascular disease among adults at cardiovascular-kidney-metabolic syndrome stage 0.
  • Prospective cohort study analyzing 691 adults (47.6% women; mean age 40.4 years) free of cardiovascular-kidney-metabolic risk factors from the Tehran Lipid and Glucose Study.
  • Followed participants for a median of 19.6 years to record incident atherosclerotic cardiovascular disease events.
  • Assessed body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio using Cox proportional hazards models and restricted cubic splines adjusted for education level and the PREVENT risk score.
  • During follow-up, 58 participants (8.4%) developed incident atherosclerotic cardiovascular disease, with an overall crude incidence rate of 4.95 per 1,000 person-years.
  • Adjusted hazard ratios were significant per 5 cm higher waist circumference (HR 1.59; 95% CI, 1.28–1.98; P <0.001), 0.05 higher waist-to-height ratio (HR 2.23; 95% CI, 1.47–3.40; P <0.001), and 0.05 higher waist-to-hip ratio (HR 1.67; 95% CI, 1.34–2.08; P <0.001).
  • Body mass index showed no statistically significant linear association with incident disease per 1 kg/m² increment (adjusted HR 1.15; 95% CI, 0.98–1.35; P = 0.083).

Study Design

Type

Cohort (n=691)

Multicenter

No

Structured PICO

Do higher obesity measures increase the risk of incident ASCVD in adults at cardiovascular-kidney-metabolic syndrome stage 0?

P
Population
691 adults aged 30 years and older at cardiovascular-kidney-metabolic syndrome stage 0, free of traditional risk factors, followed for a median of 19.6 years.
E
Exposure
Higher obesity measures (body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio)
C
Comparator
Lower obesity measures (analyzed continuously and by sex-specific tertiles)
O
Outcome
Incident atherosclerotic cardiovascular disease (ASCVD), defined as fatal or non-fatal stroke and fatal or non-fatal coronary heart disease, over a median follow-up of 19.6 yearshard clinical

Main Result

Hazard Ratio: 1.59 (95% CI 1.28–1.98)

p-value: p=<0.001

Even in individuals without traditional cardiovascular-kidney-metabolic risk factors (CKM stage 0), higher abdominal obesity measures (waist circumference, waist-to-height ratio, waist-to-hip ratio) are associated with a significantly increased long-term risk of ASCVD, whereas BMI is not.

Limitations

  • BMI and central adiposity measures may not accurately capture true visceral or subcutaneous fat.
  • Residual confounding from unmeasured variables such as diet, physical activity, and social determinants of health.
  • CKM stage 0 was defined only at baseline, and risk factors may have changed over time.
  • Lack of imaging or biomarker data to definitively rule out baseline subclinical cardiovascular disease.
  • Study population was restricted to a single urban district in Tehran, limiting generalizability to other ethnicities and regions.
  • Direct measures of subclinical CVD (i.e., imaging/biomarker data) were unavailable
  • No adjustment for multiple comparisons was applied due to the exploratory nature of the study

Cite This Study

Masrouri et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic syndrome (CKM) stage 0 (n=691). Higher waist circumference (per 5 cm increment) vs. Lower waist circumference was evaluated on Incident atherosclerotic cardiovascular disease (ASCVD) (HR 1.59, 95% CI 1.28-1.98, p=<0.001). In adults at cardiovascular-kidney-metabolic syndrome stage 0, each 5 cm higher waist circumference was associated with a 59% higher risk of incident atherosclerotic cardiovascular disease (HR 1.59).

synapsesocial.com/papers/6aa5542f327956e4761fa05chttps://doi.org/10.1186/s13098-026-02283-0
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The association between various indices of obesity and severity of atherosclerosis in adults in the north of Iran2016 · 29 citations
  2. 2Evaluation of Waist Circumference to Predict Cardiovascular Risk Factors in an Overweight Tehranian Population: Findings from Tehran Lipid and Glucose Study2005 · 14 citations
  3. 3Comparative analysis of 16 baseline obesity and lipid-related indices for cardiovascular disease risk prediction in adults with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study2025 · 12 citations
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  5. 5Associations of visceral fat accumulation with cardiovascular disease across cardiovascular-kidney-metabolic syndrome stages 0–3: mediation effects of arterial stiffness in a prospective cohort study2026 · 1 citations