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Hypertriglyceridemic Waist: A Marker of the Atherogenic Metabolic Triad (Hyperinsulinemia; Hyperapolipoprotein B; Small, Dense LDL) in Men?

Lemieux, Isabelle, Pascot, Agnès, Couillard, Charles, Lamarche, Benoı̂t, Tchernof, André, Alméras, Natalie, Bergeron, Jean, Gaudet, Daniel, Tremblay, Gérald, Prud’homme, Denis, Nadeau, André, Després, Jean-Pierre·2000·Circulation

DOI 10.1161/01.cir.102.2.179

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Abstract

Background —The present study tested the hypothesis that simple variables, such as waist circumference and fasting plasma triglyceride (TG) concentrations, could be used as screening tools for the identification of men characterized by a metabolic triad of nontraditional risk factors (elevated insulin and apolipoprotein [apo] B and small, dense LDL particles). Methods and Results —Results of the metabolic study (study 1) conducted on 185 healthy men indicate that a large proportion (>80%) of men with waist circumference values ≥90 cm and with elevated TG levels (≥2.0 mmol/L) were characterized by the atherogenic metabolic triad. Validation of the model in an angiographic study (study 2) on a sample of 287 men with and without coronary artery disease (CAD) revealed that only men with both elevated waist and TG levels were at increased risk of CAD (odds ratio of 3.6, P <0.03) compared with men with low waist and TG levels. Conclusions —It is suggested that the simultaneous measurement and interpretation of waist circumference and fasting TG could be used as inexpensive screening tools to identify men characterized by the atherogenic metabolic triad (hyperinsulinemia, elevated apo B, small, dense LDL) and at high risk for CAD.

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Parámetros lipídicos y objetivos terapéuticos
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Bridging east and west: integrative approaches to obesity management through traditional Chinese medicine
Li, Q., Liu, Z., & Zhang, X. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1644381 · Cited by 3
APOE4 and chronic health risk factors are associated with sex-specific preclinical Alzheimer’s disease neuroimaging biomarkers
Losinski, G., Key, M. N., Vidoni, E. D., Clutton, J. E., Morris, J. K., Burns, J. M., & Watts, A. S. (2025) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2025.1531062 · Cited by 5
A Comparative Evaluation of Adiposity Indices for Predicting Visceral Adipose Tissue Magnitude: Insights from NHANES 2011–2018
Torun, C., & Ankarali, H. (2025) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2025.0005 · Cited by 3
“8 This concept builds on the complex phenotype of visceral obesity, which includes adipose tissue storage dysfunction and ectopic triglyceride deposition in various areas, including the liver.”
Cardiometabolic Risk Markers for Aboriginal and Torres Strait Islander Children and Youths: A Systematic Review of Data Quality and Population Prevalence
O’Bryan, E., McKay, C. D., Eades, S., Gubhaju, L., Pearson, O. R., Kerr, J. A., Brown, A. D. H., & Azzopardi, P. S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20136228 · Cited by 5
Association between hypertriglyceridemic waist phenotype and hypogonadism in Taiwanese adult men
Wang, S.-K., Lee, M., Hung, C.-L., Chen, H.-H., Liao, C., & Chiu, Y. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265629 · Cited by 3
Visceral adiposity indicators and cardiovascular risk in hemodialytic patients
Melo, D. D. A., dos Santos, A. D., Furtado, E., França, A. K., dos Santos, E. D., de Arruda, I. D., de Carvalho, T. R., Pinho, C. P. S., Diniz, A. D. S., & de Lemos, M. D. C. C. (2021) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000421 · Cited by 3
HYPERTRIGLYCERIDEMIC WAIST AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS
Silva, L. C. D. S. E., Silva, S. L. B. E., de Oliveira, Á. M. S., de Araújo, J. R., de Arruda, I. D., Maio, R., & de Lemos, M. D. C. C. (2020) · Revista Paulista de Pediatria · doi:10.1590/1984-0462/2020/38/2019073 · Cited by 3
Visceral Fat Area Evaluation by Computed Tomography Correlates with Visceral Fat Volume
Mizui, M., Mizoguchi, Y., Senda, Y., Yokoi, M., & Tashiro, T. (2017) · Global Journal of Health Science · doi:10.5539/gjhs.v9n10p78 · Cited by 3
“(DeFronzo & Ferrannini, 1991; Fujioka, Matsuzawa, Tokunaga, & Tarui, 1987; Lemieux et al., 2000) Traditionally, the body mass index (BMI) has been used as a measure of abdominal obesity; however, in recent years, more and more studies use measures of visceral fat.”
Background
Sex disparity in the association between hypertriglyceridemic waist phenotype and arterial stiffness in Chinese healthy subjects
Chen, K., Li, P., Li, Y.-J., Li, T., & Mu, Y. (2016) · Postgraduate medicine · doi:10.1080/00325481.2016.1214060 · Cited by 3
“[24] CAD British N = 185 men, mean age = 43.”
Background
HUBUNGAN INDEKS MASSA TUBUH DAN ASUPAN ASAM LEMAK JENUH DENGAN RASIO LDL/HDL SERUM LANSIA
Affanti, K. A. N., & AryuCandra, K. (2015) · doi:10.14710/jnc.v4i2.10064 · Cited by 3
“Hal ini sesuai dengan penelitian sebelumnya yaitu pada penelitian Lemieux Let al yang menyatakan bahwa IMT yang semakin meningkat berhubungan dengan meningkatnya kadar kolesterol, menurunkan HDL,dan meningkatkan LDL.(15) Selain itu, berdasarkan analisis multivariat IMT memiliki hubungan yang signifikan dibanding denga…”
Background
Circunferencia hipertrigliceridémica y perfil de riesgo cardiometabólico en adolescentes normopeso y con exceso de peso
Original, I., Ruiz-Fernández, N., Rangel, A., Rodríguez, C., Rodríguez, L., & Rodríguez, V. (2015) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v63n2.49185 · Cited by 3
Clinical Strategies for Managing Dyslipidemias
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JTT-130, a Novel Intestine-Specific Inhibitor of Microsomal Triglyceride Transfer Protein, Improves Hyperglycemia and Dyslipidemia Independent of Suppression of Food Intake in Diabetic Rats
Sakata, S., Ito, M., Mera, Y., Sasase, T., Yamamoto, H., Kakutani, M., & Ohta, T. (2014) · Journal of Diabetes Research · doi:10.1155/2014/803832 · Cited by 3
“suggested that visceral obesity and the hypertriglyceridemic waist phenotype are central components [4].”
Outcome of adrenal tissue fragments allotransplantation: the impact of cryopreservation.
Alabedalkarim, N., Bozhok, G., Legach, E., Ustichenko, V., Zubov, P., Bilyavskaya, S. B., Dudetskaya, G., Bondarenko, T., & Hoffmann, M. (2012) · Cryobiology · doi:10.1016/j.cryobiol.2012.05.013 · Cited by 3
[Quantification of visceral adipose tissue using magnetic resonance imaging compared with anthropometry, in type 2 diabetic patients].
García, C. S., Barrera, F., Labbé, P., Liberona, J., Arrese, M., Irarrazabal, P., Tejos, C., & Uribe, S. (2012) · Revista médica de Chile (Impresa) · doi:10.4067/s0034-98872012001200003 · Cited by 3
Avaliação da relação entre circunferência abdominal e altura como preditora de risco cardiometabólico em crianças de 6 a 10 anos
Kuba, V. M. (2012) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2012.tde-25042012-102817 · Cited by 1
Clinical Evaluation for Genetic and Secondary Causes of Dyslipidemia
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Effects of Selected Anthropometric Parameters on Plasma Lipoproteins, Fatty Acid Composition, and Lipoperoxidation
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Clustering of Metabolic Syndrome and its Risk Factors among Adult Nigerians in a National Health Insurance Scheme Primary Care Clinic of a Tertiary Hospital in South-Eastern Nigeria
Iloh, G. U. P. (2014) · American Journal of Health Research · doi:10.11648/j.ajhr.20140202.11 · Cited by 1
“[32] The associated risk factors include physical inactivity [6,15] and other enhancing risk factors.”
Background
Obesity and Cardiovascular Risk Factors
Santi-Cano, M. J. (2013) · Obesity & Control Therapies Open Access · doi:10.15226/2374-8354/1/1/00105 · Cited by 4
“It is suggested that hypertriglyceridemic waist could have been helpful to identify non-obese metabolically unhealthy individuals with an excess of visceral adipose tissue [38].”
Avaliação por imagem da área de gordura visceral e suas correlações com alterações metabólicas
Roriz, A. K. C., Mello, A. L., Guimarães, J. F., dos Santos, F. C., Medeiros, J. M. B., & Sampaio, L. R. (2010) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2010005000159 · Cited by 3
Residual cardiovascular risk is tracked by apolipoprotein B in coronary patients with elevated serum triglyceride levels: the ESC EORP EUROASPIRE IV survey
Leiviskä, J., Sundvall, J., Jauhiainen, M., Kotseva, K., Tuomilehto, J., Backer, G. D., Tokgözoğlu, L. S., Reiner, Ž., & Bacquer, D. D. (2025) · Clinica Chimica Acta · doi:10.1016/j.cca.2025.120653 · Cited by 2
Regional and systemic adipose mass and peripheral conduit artery function
Wakeham, D. J., Beckman, B. E., Mashayekhi, M., Luther, J. M., Garner, E. M., Perkins, B., Gottlieb, J., Niswender, K. D., Hearon, C. M., Brown, N. J., et al. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112408 · Cited by 2
Combination of Waist Circumference and Circulating Levels of IGFBP-2 as a Simple Screening Tool for Early Detection of Metabolic Dysfunction-Associated Steatotic Liver Disease
Rauzier, C., Chartrand, D., Alméras, N., Lemieux, I., Larose, É., Mathieu, P., Pibarot, P., Lamarche, B., Rhéaume, C., Poirier, P., et al. (2024) · Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy · doi:10.2147/dmso.s466051 · Cited by 2
“22 This criterion corresponded to a value of 230 ng/mL in men (Supplementary Figure 2A) and 260 ng/mL in women (Supplementary Figure 2B), consistent with the observation that women had higher IGFBP-2 levels than men on average.”
MethodResultSelf-citation
Finding a Link between Obesity and Senescence: A Systematic Review and Meta-Analysis
Widjaja, S. S., Rusdiana, R., Mardani, T. H., Simanullang, R. H., Jayalie, V. F., Amelia, R., & Arisa, J. (2024) · Iranian Journal of Public Health · doi:10.18502/ijph.v53i1.14679 · Cited by 1
Association among 25‐hydroxyvitamin D levels, hypertriglyceridemic‐waist phenotype, and cardiometabolic markers in individuals with type 2 diabetes mellitus from regions with high solar incidence
Oliveira, J. G. D. S., Santos, B. D. C., Santos, R. K. F., Santos, C. B., Reis, A. R., Santos, C. F. D. S., de Carvalho, G. D., Brandão-Lima, P., Rocha, V. D. S., & Pires, L. V. (2023) · American Journal of Human Biology · doi:10.1002/ajhb.23999 · Cited by 2
“…a simple and low-cost tool to assist health professionals in the identification of individuals with the metabolic triad (hyperinsulinemia, elevated apolipoprotein B, and LDL-c) proposed by Lemieux et al. (2000) observed the increase in WC associated positively with the increase in apolipoprotein B.”
Background
Association between hypertriglyceridemic-waist phenotype and circadian syndrome risk: a longitudinal cohort study
Hu, L., Liu, Y., Yang, K. Y., Chen, N., Ma, L., & Yan, Y. (2023) · HORMONES · doi:10.1007/s42000-023-00462-6 · Cited by 3
“They found that the hypertriglyceridemic-waist phenotype was a simple means of determining high risk for coronary artery disease (CAD) and the atherogenic metabolic triad [4] while also identifying this phenotype as a low-cost and easy screening tool.”
Background
Association of Hyper-Triglyceridemic Waist Phenotype and Diabetic Vascular Complication in the Chinese Population
Li, K., Cao, B., Ke, J., Yang, L.-Y., & Zhao, D. (2023) · Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy · doi:10.2147/dmso.s416668 · Cited by 2
“HWP is a particular biomarker that comprises both enlarged waist circumference and elevated TG. 8 First, Elevated triglyceride levels cause heparin to activate lipoprotein lipase and increase intravascular lipolysis of circulating triglycerides, thereby increasing tissue exposure to free fatty acids, ultimately leadin…”
BackgroundMethodInfluential
PHYSICAL INACTIVITY AND HIGH SEDENTARY BEHAVIOR ARE ASSOCIATED WITH HYPERTRIGLYCERIDEMIC WAIST IN ELDERLY
dos Santos, L., da Cruz, L. A., Fagunde, L. C., Mendes, J. M., Brito, T. A., Henrique-Fernandes, M., Coqueiro, R. D. S., & Carneiro, J. A. O. (2021) · Estudos interdisciplinares sobre o envelhecimento · doi:10.22456/2316-2171.98245 · Cited by 2
Insulin and glucose regulation at rest and during flight in a Neotropical nectar-feeding bat
Castro, D. L. J., de Freitas, R. M. P., Silva, S. B., de Melo, F. C. S. A., Sarandy, M. M., Ospina, E. G., Sartori, S. S. R., Gonçalves, R. V., & Freitas, M. B. (2021) · Mammalian Biology · doi:10.1007/s42991-021-00146-x · Cited by 3
Hypertriglyceridemic Waist in Patients with Type 2 Diabetes: Its Relationship to Selected Markers of Vascular Damage
Karásek, D., Spurná, J., Mačáková, D., Cibičková, Ľ., Krystyník, O., Kucerova, V., Úlehlová, J., & Slavík, L. (2021) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2021.0019 · Cited by 2
“2,7,13 Chronic inﬂammation and insulin resistance are likely to represent the link between visceral obesity and adverse metabolic changes.”

Authors: Lemieux, I., Pascot, A., Couillard, C., Lamarche, B., Tchernof, A., Alméras, N., Bergeron, J., Gaudet, D., Tremblay, G., Prud’homme, D., Nadeau, A., & Després, J.-P.
Affiliations: Centre hospitalier de l'Université Laval (CA)
From the Quebec Heart Institute, Laval Hospital Research Center; the Lipid Research Center, CHUL Research Center; the Physical Activity Sciences Laboratory, Laval University; the Diabetes Research Unit, CHUL Research Center, Ste-Foy; and the Lipid Clinic, Chicoutimi Hospital, Chicoutimi, Québec, Canada.
ORCID: Lemieux, Isabelle
Couillard, Charles
Lamarche, Benoı̂t
Bergeron, Jean
Gaudet, Daniel
Prud’homme, Denis
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2000-07-11
Volume: 102
Issue: 2
Pages: 179-184
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.102.2.179
OpenAlex: W1991251155
Cited by: 937
References: 0
Citations by year: 2026: 10 · 2025: 19 · 2024: 23 · 2023: 28 · 2022: 31 · 2021: 29 · 2020: 30 · 2019: 26 · 2018: 35 · 2017: 29 · 2016: 38 · 2015: 38 · 2014: 42 · 2013: 42 · 2012: 49
FWCI: 18.34
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: American Heart Association
Heart and Stroke Foundation of Canada
Medical Research Council Canada
Medical Research Council
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords: hypertriglyceridemic waist phenotype, waist circumference, fasting plasma triglycerides, hyperinsulinemia, apolipoprotein B, small dense LDL, coronary artery disease risk, cardiovascular screening, men
MeSH terms: Abdomen, Adult, Apolipoproteins B, Body Composition, Coronary Artery Disease, Coronary Disease, Humans, Hyperinsulinism, Lipoproteins, LDL, Male, Mass Screening, Middle Aged, Predictive Value of Tests, Risk Factors, Triglycerides, Hypertriglyceridemia, Biomarkers, Coronary Angiography

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Hypertriglyceridemic Waist: A Marker of the Atherogenic Metabolic Triad (Hyperinsulinemia; Hyperapolipoprotein B; Small, Dense LDL) in Men?

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