The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease

Chin Feng Hsuan; Fang Ju Lin; Thung Lip Lee; Kai Chien Yang; Wei Kung Tseng; Yen Wen Wu; Wei Hsian Yin; Hung I. Yeh; Jaw Wen Chen; Chau Chung Wu; Wei Tien Chang; Yi Heng Lee; Jaw Wen Chen; Huey Herng Sheu; I. Chang Hsieh; Yih Sharng Chen; Ming En Liu; Chen Huan Chen; Lian Yu Lin; Hung I. Yeh; Shih Hsien Sung; Ping Yen Liu; I. Hui Wu; Zhi Hong Wang; Kuan Ming Chiu; Chi Tai Kuo; Tzung Dau Wang; Chung Lieh Hung; Chih Hsien Wang; Chun Chieh Wang; Chih Yuan Wang; Jiann Shing Jeng; Tsung Hsien Lin; Hsien Li Kao; Pao Hsien Chu; Fang Ju Lin; Zhih Cherng Chen; Kuan Cheng Chang; Wei Hsian Yin; Wei Kung Tseng

doi:10.1038/s41598-021-04650-5

The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease

Chin Feng Hsuan, Fang Ju Lin, Thung Lip Lee, Kai Chien Yang, Wei Kung Tseng, Yen Wen Wu, Wei Hsian Yin, Hung I. Yeh, Jaw Wen Chen, Chau Chung Wu, Wei Tien Chang, Yi Heng Lee, Jaw Wen Chen, Huey Herng Sheu, I. Chang Hsieh, Yih Sharng Chen, Ming En Liu, Chen Huan Chen, Lian Yu Lin, Hung I. YehShih Hsien Sung, Ping Yen Liu, I. Hui Wu, Zhi Hong Wang, Kuan Ming Chiu, Chi Tai Kuo, Tzung Dau Wang, Chung Lieh Hung, Chih Hsien Wang, Chun Chieh Wang, Chih Yuan Wang, Jiann Shing Jeng, Tsung Hsien Lin, Hsien Li Kao, Pao Hsien Chu, Fang Ju Lin, Zhih Cherng Chen, Kuan Cheng Chang, Wei Hsian Yin, Wei Kung Tseng

Research output: Contribution to journal › Article › peer-review

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Abstract

Obesity is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, ‘obesity paradox’ is observed in patients with coronary artery disease while defining obesity by body mass index (BMI). The purpose of this study is to identify a better anthropometric parameter to predict cardiovascular events in patients with ASCVD. The study was conducted using the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. A total of 6,920 adult patients with stable ASCVD, enrolled from January 2010 to November 2014, were included, with a mean age of 65.9 years, 73.9% males, and a mean BMI of 26.3 kg/m² at baseline. These patients were followed up for a median of 2.5 years. The study endpoint was the composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Multivariable Cox proportional hazards regression showed a significant positive association between waist-to-BMI ratio and MACE (adjusted hazard ratio 1.69 per cm‧m²/kg increase in waist-to-BMI ratio, 95% CI 1.12–2.49, p = 0.01) after adjusting for potential risk factors and confounders. Traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, or newer waist-based indices, such as body roundness index and a body shape index, did not show any significant linear associations (p = 0.09, 0.30, 0.89, 0.54, 0.79 and 0.06, respectively). In the restricted cubic spline regression analysis, the positive dose–response association between waist-to-BMI ratio and MACE persisted across all the range of waist-to-BMI ratio. The positive dose–response association was non-linear with a much steeper increase in the risk of MACE for waist-to-BMI ratio > 3.6 cm‧m²/kg. In conclusion, waist-to-BMI ratio may function as a positive predictor for the risk of MACE in established ASCVD patients.

Original language	English
Article number	804
Journal	Scientific Reports
Volume	12
Issue number	1
DOIs	https://doi.org/10.1038/s41598-021-04650-5
Publication status	Published - Dec 2022
Externally published	Yes

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UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/s41598-021-04650-5

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Hsuan, C. F., Lin, F. J., Lee, T. L., Yang, K. C., Tseng, W. K., Wu, Y. W., Yin, W. H., Yeh, H. I., Chen, J. W., Wu, C. C., Chang, W. T., Lee, Y. H., Chen, J. W., Sheu, H. H., Hsieh, I. C., Chen, Y. S., Liu, M. E., Chen, C. H., Lin, L. Y., ... Tseng, W. K. (2022). The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease. Scientific Reports, 12(1), Article 804. https://doi.org/10.1038/s41598-021-04650-5

Hsuan, CF, Lin, FJ, Lee, TL, Yang, KC, Tseng, WK, Wu, YW, Yin, WH, Yeh, HI, Chen, JW, Wu, CC, Chang, WT, Lee, YH, Chen, JW, Sheu, HH, Hsieh, IC, Chen, YS, Liu, ME, Chen, CH, Lin, LY, Yeh, HI, Sung, SH, Liu, PY, Wu, IH, Wang, ZH, Chiu, KM, Kuo, CT, Wang, TD, Hung, CL, Wang, CH, Wang, CC, Wang, CY, Jeng, JS, Lin, TH, Kao, HL, Chu, PH, Lin, FJ, Chen, ZC, Chang, KC, Yin, WH & Tseng, WK 2022, 'The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease', Scientific Reports, vol. 12, no. 1, 804. https://doi.org/10.1038/s41598-021-04650-5

@article{0cd116de67ff47ac9a2a3f1579bb74d7,

title = "The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease",

abstract = "Obesity is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, {\textquoteleft}obesity paradox{\textquoteright} is observed in patients with coronary artery disease while defining obesity by body mass index (BMI). The purpose of this study is to identify a better anthropometric parameter to predict cardiovascular events in patients with ASCVD. The study was conducted using the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. A total of 6,920 adult patients with stable ASCVD, enrolled from January 2010 to November 2014, were included, with a mean age of 65.9 years, 73.9% males, and a mean BMI of 26.3 kg/m2 at baseline. These patients were followed up for a median of 2.5 years. The study endpoint was the composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Multivariable Cox proportional hazards regression showed a significant positive association between waist-to-BMI ratio and MACE (adjusted hazard ratio 1.69 per cm‧m2/kg increase in waist-to-BMI ratio, 95% CI 1.12–2.49, p = 0.01) after adjusting for potential risk factors and confounders. Traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, or newer waist-based indices, such as body roundness index and a body shape index, did not show any significant linear associations (p = 0.09, 0.30, 0.89, 0.54, 0.79 and 0.06, respectively). In the restricted cubic spline regression analysis, the positive dose–response association between waist-to-BMI ratio and MACE persisted across all the range of waist-to-BMI ratio. The positive dose–response association was non-linear with a much steeper increase in the risk of MACE for waist-to-BMI ratio > 3.6 cm‧m2/kg. In conclusion, waist-to-BMI ratio may function as a positive predictor for the risk of MACE in established ASCVD patients.",

author = "Hsuan, {Chin Feng} and Lin, {Fang Ju} and Lee, {Thung Lip} and Yang, {Kai Chien} and Tseng, {Wei Kung} and Wu, {Yen Wen} and Yin, {Wei Hsian} and Yeh, {Hung I.} and Chen, {Jaw Wen} and Wu, {Chau Chung} and Chang, {Wei Tien} and Lee, {Yi Heng} and Chen, {Jaw Wen} and Sheu, {Huey Herng} and Hsieh, {I. Chang} and Chen, {Yih Sharng} and Liu, {Ming En} and Chen, {Chen Huan} and Lin, {Lian Yu} and Yeh, {Hung I.} and Sung, {Shih Hsien} and Liu, {Ping Yen} and Wu, {I. Hui} and Wang, {Zhi Hong} and Chiu, {Kuan Ming} and Kuo, {Chi Tai} and Wang, {Tzung Dau} and Hung, {Chung Lieh} and Wang, {Chih Hsien} and Wang, {Chun Chieh} and Wang, {Chih Yuan} and Jeng, {Jiann Shing} and Lin, {Tsung Hsien} and Kao, {Hsien Li} and Chu, {Pao Hsien} and Lin, {Fang Ju} and Chen, {Zhih Cherng} and Chang, {Kuan Cheng} and Yin, {Wei Hsian} and Tseng, {Wei Kung}",

note = "Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

doi = "10.1038/s41598-021-04650-5",

language = "English",

volume = "12",

journal = "Scientific Reports",

issn = "2045-2322",

publisher = "Nature Research",

number = "1",

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TY - JOUR

T1 - The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease

AU - Hsuan, Chin Feng

AU - Lin, Fang Ju

AU - Lee, Thung Lip

AU - Yang, Kai Chien

AU - Tseng, Wei Kung

AU - Wu, Yen Wen

AU - Yin, Wei Hsian

AU - Yeh, Hung I.

AU - Chen, Jaw Wen

AU - Wu, Chau Chung

AU - Chang, Wei Tien

AU - Lee, Yi Heng

AU - Chen, Jaw Wen

AU - Sheu, Huey Herng

AU - Hsieh, I. Chang

AU - Chen, Yih Sharng

AU - Liu, Ming En

AU - Chen, Chen Huan

AU - Lin, Lian Yu

AU - Yeh, Hung I.

AU - Sung, Shih Hsien

AU - Liu, Ping Yen

AU - Wu, I. Hui

AU - Wang, Zhi Hong

AU - Chiu, Kuan Ming

AU - Kuo, Chi Tai

AU - Wang, Tzung Dau

AU - Hung, Chung Lieh

AU - Wang, Chih Hsien

AU - Wang, Chun Chieh

AU - Wang, Chih Yuan

AU - Jeng, Jiann Shing

AU - Lin, Tsung Hsien

AU - Kao, Hsien Li

AU - Chu, Pao Hsien

AU - Lin, Fang Ju

AU - Chen, Zhih Cherng

AU - Chang, Kuan Cheng

AU - Yin, Wei Hsian

AU - Tseng, Wei Kung

PY - 2022/12

Y1 - 2022/12

N2 - Obesity is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, ‘obesity paradox’ is observed in patients with coronary artery disease while defining obesity by body mass index (BMI). The purpose of this study is to identify a better anthropometric parameter to predict cardiovascular events in patients with ASCVD. The study was conducted using the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. A total of 6,920 adult patients with stable ASCVD, enrolled from January 2010 to November 2014, were included, with a mean age of 65.9 years, 73.9% males, and a mean BMI of 26.3 kg/m2 at baseline. These patients were followed up for a median of 2.5 years. The study endpoint was the composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Multivariable Cox proportional hazards regression showed a significant positive association between waist-to-BMI ratio and MACE (adjusted hazard ratio 1.69 per cm‧m2/kg increase in waist-to-BMI ratio, 95% CI 1.12–2.49, p = 0.01) after adjusting for potential risk factors and confounders. Traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, or newer waist-based indices, such as body roundness index and a body shape index, did not show any significant linear associations (p = 0.09, 0.30, 0.89, 0.54, 0.79 and 0.06, respectively). In the restricted cubic spline regression analysis, the positive dose–response association between waist-to-BMI ratio and MACE persisted across all the range of waist-to-BMI ratio. The positive dose–response association was non-linear with a much steeper increase in the risk of MACE for waist-to-BMI ratio > 3.6 cm‧m2/kg. In conclusion, waist-to-BMI ratio may function as a positive predictor for the risk of MACE in established ASCVD patients.

AB - Obesity is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, ‘obesity paradox’ is observed in patients with coronary artery disease while defining obesity by body mass index (BMI). The purpose of this study is to identify a better anthropometric parameter to predict cardiovascular events in patients with ASCVD. The study was conducted using the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. A total of 6,920 adult patients with stable ASCVD, enrolled from January 2010 to November 2014, were included, with a mean age of 65.9 years, 73.9% males, and a mean BMI of 26.3 kg/m2 at baseline. These patients were followed up for a median of 2.5 years. The study endpoint was the composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Multivariable Cox proportional hazards regression showed a significant positive association between waist-to-BMI ratio and MACE (adjusted hazard ratio 1.69 per cm‧m2/kg increase in waist-to-BMI ratio, 95% CI 1.12–2.49, p = 0.01) after adjusting for potential risk factors and confounders. Traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, or newer waist-based indices, such as body roundness index and a body shape index, did not show any significant linear associations (p = 0.09, 0.30, 0.89, 0.54, 0.79 and 0.06, respectively). In the restricted cubic spline regression analysis, the positive dose–response association between waist-to-BMI ratio and MACE persisted across all the range of waist-to-BMI ratio. The positive dose–response association was non-linear with a much steeper increase in the risk of MACE for waist-to-BMI ratio > 3.6 cm‧m2/kg. In conclusion, waist-to-BMI ratio may function as a positive predictor for the risk of MACE in established ASCVD patients.

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The waist-to-body mass index ratio as an anthropometric predictor for cardiovascular outcome in subjects with established atherosclerotic cardiovascular disease

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