Normal-Weight Central Obesity May Up Mortality in CAD Patients

Deborah Brauser

February 11, 2016

PHILADELPHIA, PA — Having a normal body-mass index (BMI) but a high waist circumference (WC) or high waist/hip ratio (WHR), representing "normal-weight central obesity," can increase risk of mortality in patients with coronary artery disease, according to new research[1].

The analysis of more than 7000 CAD patients from five cohort studies showed that those with a normal BMI and high WHR or high WC had significantly higher mortality risk vs those with lower WHR or WC (both comparisons, P<0.001).

In the overall population, having a high WHR alone was associated with twice the mortality risk as a low WHR. High WHR was also associated with increased mortality in the women-only and men-only subgroups (all comparisons, P<0.001). However, having a high WC was significantly associated with a higher mortality risk only in the men (P=0.02).

"When combined with BMI, WC in men and WHR in women may provide additional prognostic value" when it comes to mortality risk, lead author Dr Saurabh Sharma (Einstein Medical Center, Philadelphia, PA) and colleagues write.

"We suggest that among independent anthropometric measures of obesity, an elevated WHR as compared with WC or BMI provides an improved risk stratification of older adults," they add.

The findings were published online February 6, 2016 in Mayo Clinic Proceedings.

At Higher Risk

The investigators examined data from five cohort studies conducted in Minnesota and California in the US; Copenhagen, Denmark; Dijon, France; and Daegu, Korea, from January 1980 through December 2008.

For this analysis, they included 7057 patients with CAD who were at least 65 years of age (mean age 73 years; 53% women) and who had WC and WHR measured.

Normal BMI was defined as 18.5 to 24.9 kg/m2; high WC was above 102 cm for men and 88 cm for women; high WHR was above 0.9 for men and 0.85 for women. A total of 33.9% of the patients had normal-weight central obesity.

The risk for mortality was highest for the participants who had normal-range BMI and high WHR vs those with normal BMI and low WHR (hazard ratio [HR] 1.29, 95% CI 95% CI 1.14–1.46). The HR was 1.15 for those with overweight BMI and high WHR (95% CI 1.01-1.30).

The lowest mortality risk was for those with obese BMI and low WHR (HR 0.55); and even those with obese BMI and high WHR were not at significant risk.

Compared with the normal-BMI/low-WC group, those who had normal BMI/high WC had a hazard ratio for mortality of 1.29 (95% CI 1.12–1.50).

When looking specifically at high WHR only, this measure was a significant predictor of mortality in the overall population (HR 2.14, 95% CI 1.93–2.38), in men (HR 3.53, 95% CI 2.87–4.35), and in women (HR 1.65, 95% CI 1.45–1.88).

In addition, the HR for mortality was 1.12 in the men with a high WC (95% CI 1.01–1.24).

"Our results highlight the need to combine measures of total and central obesity in adiposity-related risk assessment in the elderly population," conclude the investigators.

Sharma reports no relevant financial relationships. Disclosures for the coauthors are listed in the article.

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