SCD Risk Directly Tied to Waist-Hip Ratio in Nonsmokers

Sudden-Death Risk Directly Related to Waist-Hip Ratio in Nonsmokers: ARIC Analysis

Pam Harrison

December 12, 2014

MINNEAPOLIS, MN — Routine measures of obesity are significantly associated with an increased risk of sudden cardiac death (SCD) among middle-aged citizens who do not smoke, findings from the Atherosclerosis Risk in Communities (ARIC) study indicate[1].

However, only the waist-to-hip ratio, an index of reflecting both subcutaneous and intra-abdominal fat, was directly associated with SCD, while measures of body-mass index (BMI) and waist circumference were indirectly associated with SCD, apparently via effects on traditional CVD risk factors.

"Data on the relationship between obesity and SCD are sparse and derived largely from community-based autopsy studies and from a small number of cohort studies," lead author Dr Selcuk Adabag (Veterans Affairs Medical Center and the University of Minnesota, Minneapolis) and colleagues write. "This analysis extends our current knowledge regarding the hazards of excess body weight on risk of SCD."

The study was published online November 19, 2014 in Heart. The results were first presented at the Heart Rhythm Society 2012 Scientific Sessions, as reported by heartwire at the time.

ARIC is a multicenter prospective study investigating the etiology of atherosclerotic disease in a middle-aged multiracial population living in four communities in the US. The current analysis included 14 941 men (45%) and women (55%) between 45 and 64 years of age (mean 54 years) at baseline; 26% were African American and the remainder were white. About one-fourth were smokers.

During a mean follow-up of 12.6 years, there were a total of 253 out-of-hospital SCDs, one-third of them occurring in females and 42% of them occurring among African American participants.

Participants who died suddenly had a significantly greater baseline BMI of 28.4 kg/m2, vs 27.6 kg/m2 among those who did not (P=0.01).

Baseline waist circumference was also significantly greater among those who died suddenly, at 101 cm, compared with 96.8 cm for those who did not (P<0.0001). The waist-to-hip ratio was also significantly higher, at 0.97 among those who died suddenly compared with 0.92 among those who did not (P<0.0001).

After adjustment for potential mediators of SCD, including demographics, hypertension, diabetes, lipid profile, prevalent coronary heart disease, heart failure, and left ventricular hypertrophy, nonsmokers with the highest waist-to-hip ratio (>0.95 for women and >1.01 for men) had double the risk of SCD compared with those with a normal waist-to-hip ratio (hazard ratio 2.03, P=0.003), investigators add.

In smokers, however, none of the obesity measures was significantly related to SCD risk in a fully adjusted model.

The authors declared no financial relationships relevant to the ARIC study.

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