Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies
Open accessAbstract
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.
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De Koning et al. have shown that a decrease of 1 cm in waist circumference reduces the relative risk of a CVD event by 2%.
“De Koning et al. have shown that a decrease of 1 cm in waist circumference reduces the relative risk of a CVD event by 2% [84].”
An increase of 1 cm in waist circumference resulted in a 2% increase in cardiovascular disease risk.
“Findings from a large meta‐regression analysis exploring WC as a predictor of CVD reported an increase of 1 cm in WC resulted in a 2% increase in CVD risk. 84”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [84]
Waist circumference is often used as a surrogate marker of abdominal fat mass, as changes in waist circumference are associated with changes in intra-abdominal fat and in turn changes in health risk profile.
“WC is often used as a surrogate marker of abdominal fat mass, as changes in WC are associated with changes in intra‐abdominal fat and in turn changes in health risk profile. 84”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [84]
Abdominal adiposity is independently associated with all-cause mortality and is recognized as a better predictor of obesity-related conditions than either body weight or BMI.
“Beyond total body fat, abdominal adiposity is independently associated with all‐cause mortality and is recognized as a better predictor of obesity‐related conditions than either BW or BMI. 83 , 84 , 85”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [84]
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- Authors
- de Koning, L., Merchant, A. T., Pogue, J., & Anand, S. S.
- Affiliations
- McMaster University (CA)
- Hamilton General Hospital (CA)
- ORCID
- Merchant, A. T.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-03-23
- Volume
- 28
- Issue
- 7
- Pages
- 850-856
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2134326473
- Cited by
- 1,073
- References
- 49
- Citations by year
- 2026: 28 · 2025: 60 · 2024: 54 · 2023: 43 · 2022: 61 · 2021: 56 · 2020: 54 · 2019: 71 · 2018: 60 · 2017: 48 · 2016: 66 · 2015: 56 · 2014: 74 · 2013: 73 · 2012: 58
- FWCI
- 31.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- European Heart Journal (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- waist circumference, waist-to-hip ratio, cardiovascular risk, abdominal obesity, cardiovascular events, cardiovascular risk assessment, anthropometric measures
- MeSH terms
- Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Obesity, Prospective Studies, Risk Factors, Randomized Controlled Trials as Topic, Risk Assessment, Waist-Hip Ratio
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