European Heart Journal Advance Access published online on April 2, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm026
Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies
1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8L 2X2
2 Department of Medicine, McMaster University, 4th floor East Wing, Hamilton General Hospital, 237 Barton St. East, Hamilton, Ontario, Canada L8L 2X2
Received 18 December 2006; revised 14 February 2007; accepted 23 February 2007.
* Corresponding author. Tel: +1 905 527 4322 ext. 44557; fax: +1 905 577 1490. E-mail address: anands{at}mcmaster.ca
Aims: The objectives of this study were to determine the association of waist circumference (WC) and waist-to-hip ratio (WHR) with the risk of incident cardiovascular disease (CVD) events and to determine whether the strength of association of WC and WHR with CVD risk is different.
Methods and results: This meta-regression analysis used a search strategy of keywords and MeSH terms to identify prospective cohort studies and randomized clinical trials of CVD risk and abdominal obesity from the Medline, Embase, and Cochrane databases. Fifteen articles (n = 258 114 participants, 4355 CVD events) reporting CVD risk by categorical and continuous measures of WC and WHR were included. For a 1 cm increase in WC, the relative risk (RR) of a CVD event increased by 2% (95% CI: 1–3%) overall after adjusting for age, cohort year, or treatment. For a 0.01 U increase in WHR, the RR increased by 5% (95% CI: 4–7%). These results were consistent in men and women. Overall risk estimates comparing the extreme quantiles of each measure suggested that WHR was more strongly associated with CVD than that for WC (WHR: RR = 1.95, 95% CI: 1.55–2.44; WC: RR = 1.63, 95% CI: 1.31–2.04), although this difference was not significant. The strength of association for each measure was similar in men and women.
Conclusion: WHR and WC are significantly associated with the risk of incident CVD events. These simple measures of abdominal obesity should be incorporated into CVD risk assessments.
Key Words: Cardiovascular disease • Abdominal obesity • Systematic review • Meta-regression
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