The Waist-to-Height Ratio and Incidence of High LDL Cholesterol in Japanese: A Retrospective Cohort Study

Q: What are the key findings of this study?

A higher waist-to-height ratio was associated with an increased risk of incident high LDL cholesterol in both females (HR 1.95 for highest vs lowest quartile) and males (HR 1.61 for highest vs lowest quartile).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: High LDL Cholesterol (n=3934). Intervention: Waist-to-height ratio (WHtR) vs. Lowest quartile of WHtR (Quartile 1). Primary outcome: Incident high LDL-C (LDL-C ≥ 3.62 mmol/L or initiation of lipid-lowering therapy) (HR 1.95, 95% CI 1.41-2.71, p=<0.0001).

Q: What does this research mean for the field?

A higher waist-to-height ratio is significantly associated with an increased risk of incident high LDL cholesterol in both females and males. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the association between the waist-to-height ratio and future elevation of low-density lipoprotein cholesterol in a Japanese community-based cohort.

Takako Fujii; Shintaro Ishida; Makiko Abe; Miki Kawazoe; Toshiki Maeda; Chikara Yoshimura; Yori Inoue; Kazuhiro Tada; Koji Takahashi; Kenji Ito; Kosuke Masutani; Hisatomi Arima

doi:10.5551/jat.66242

January 1, 2026Journal of Atherosclerosis and ThrombosisOpen Access

The Waist-to-Height Ratio and Incidence of High LDL Cholesterol in Japanese: A Retrospective Cohort Study

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Key result

Higher waist-to-height ratio linked to ~95% higher risk of incident high LDL cholesterol.

HR 1.95
95% CI 1.41-2.71
P<0.0001
n=3,934

Why the study?

Evidence linking waist-to-height ratio with incident high LDL cholesterol levels in Japanese populations remains limited.

Does a higher waist-to-height ratio predict the incidence of high LDL-C in adults without dyslipidemia?

Key Points

To investigate the association between the waist-to-height ratio and future elevation of low-density lipoprotein cholesterol in a Japanese community-based cohort.
Retrospective cohort study analyzing 3,934 adults aged 30-74 years without baseline dyslipidemia from the Iki Epidemiological Study of Atherosclerosis and Chronic Kidney Disease, followed between 2008 and 2019.
Waist-to-height ratio (WHtR) was categorized into sex-specific quartiles, with high LDL-C defined as LDL-C ≥ 3.62 mmol/L or initiation of lipid-lowering therapy.
Multivariable Cox proportional hazards models adjusted for age, smoking, regular alcohol consumption, regular exercise, hypertension, and diabetes mellitus.
Over a mean follow-up of 5.02 years, 466 females and 424 males developed high LDL-C levels.
Among females, the adjusted hazard ratio for quartile 4 versus quartile 1 was 1.95 (95% CI, 1.41-2.71; p for trend < 0.0001).
Among males, the adjusted hazard ratio for quartile 4 versus quartile 1 was 1.61 (95% CI, 1.18-2.21; p for trend = 0.001), with risk rising notably above a WHtR threshold of approximately 0.5.

Study Design

Type

Cohort (n=3,934)

Multicenter

No

Structured PICO

Does a higher waist-to-height ratio predict the incidence of high LDL-C in adults without dyslipidemia?

P

Population

3,934 Japanese adults aged 30-74 years without baseline dyslipidemia, followed for a mean of 5.02 years to assess the incidence of high LDL cholesterol.

E

Exposure

Higher waist-to-height ratio (WHtR) categorized into sex-specific higher quartiles (quartiles 2, 3, and 4)

C

Comparator

Lowest sex-specific quartile of waist-to-height ratio (WHtR quartile 1)

O

Outcome

Incidence of high LDL-C, defined as an LDL-C level ≥ 3.62 mmol/L or initiation of lipid-lowering therapy during follow-upsurrogate

Main Result

Hazard Ratio: 1.95 (95% CI 1.41–2.71)

Absolute Event Rate: 67.9% vs 30.2%

p-value: p=<0.0001

Limitations

Participants were health checkup attendees, which may introduce selection bias limiting generalizability.
Lifestyle factors were collected via self-reported questionnaires and may be subject to misclassification.
Unmeasured confounding factors such as hormonal status, menopause, and socioeconomic factors may have influenced the observed associations.
Information on pre-existing major diseases at baseline was unavailable.
Study was conducted in a single island community, limiting applicability to other populations.
LDL-C measurements were obtained once per examination, meaning intra-individual variability could not be accounted for.
Unmeasured baseline variables (potential residual confounding)
Conducted in a single island community in northern Kyushu, Japan (limiting generalizability)
LDL-C measurements were obtained once per examination, so intra-individual variability could not be accounted for

Implication

A higher waist-to-height ratio is a useful independent anthropometric predictor for the future development of high LDL cholesterol in Japanese adults.

Abstract

AIM: Low-density lipoprotein cholesterol (LDL-C) is a major contributor to atherosclerotic cardiovascular disease (CVD). The waist-to-height ratio (WHtR) has been proposed as a practical marker of central obesity; however, evidence linking WHtR with incident high LDL-C levels in Japanese populations remains limited. This study investigated the association between WHtR and future LDL-C elevation in a community-based cohort in Japan. METHODS: This retrospective cohort study included 3,934 adults aged 30-74 years without dyslipidemia at baseline from the Iki Epidemiological Study of Atherosclerosis and Chronic Kidney Disease. The participants were followed between 2008 and 2019. WHtR was categorized into sex-specific quartiles. Incident high LDL-C was defined as LDL-C ≥ 3.62 mmol/L or initiation of lipid-lowering therapy. Cox proportional hazards models were used to estimate the hazard ratios (HRs), after adjusting for demographic, lifestyle, and clinical factors. RESULTS: During a mean follow-up period of 5.02 years, 466 females and 424 males developed high LDL-C levels. Among females, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for quartile 4 versus quartile 1 was 1.95 (1.41-2.71; p for trend ＜0.0001). Among males, the corresponding adjusted HR (95% CI) was 1.61 (1.18-2.21; p for trend = 0.001). A higher WHtR was associated with an increased risk of incident high LDL-C in both sexes (trend p＜0.01). A WHtR threshold of approximately 0.5 corresponded to a notable increase in risk. CONCLUSION: A Higher WHtR was associated with an increased risk of incident high LDL-C. These findings suggest that WHtR may be a useful anthropometric indicator for identifying individuals at risk, although further studies are required.

Discussion

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Cite This Study

Fujii et al. (2026) conducted a cohort in High LDL Cholesterol (n=3,934). Waist-to-height ratio (WHtR) vs. Lowest quartile of WHtR (Quartile 1) was evaluated on Incident high LDL-C (LDL-C ≥ 3.62 mmol/L or initiation of lipid-lowering therapy) (HR 1.95, 95% CI 1.41-2.71, p=<0.0001). A higher waist-to-height ratio was associated with an increased risk of incident high LDL cholesterol in both females (HR 1.95 for highest vs lowest quartile) and males (HR 1.61 for highest vs lowest quartile).

synapsesocial.com/papers/6ad0fce415427f6a84040376 https://doi.org/10.5551/jat.66242

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The Waist-to-Height Ratio and Incidence of High LDL Cholesterol in Japanese: A Retrospective Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The Waist-to-Height Ratio and Incidence of High LDL Cholesterol in Japanese: A Retrospective Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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