In the Journals

Greater waist, hip measurements increase risk for MI in women

Sanne A.E. Peters

Women with increases in waist-to-hip ratio and waist circumference had a greater risk for MI compared with men, according to a study published in the Journal of the American Heart Association.

Waist-to-hip ratio had a stronger association with the risk for MI vs. BMI, especially in women.

“For doctors and patients, it is important to realize that not only the amount of excess weight, but also body fat distribution matters for their risk of heart disease,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. “Although there are currently no interventions that selectively help to lose excess weight around the waist, more intensive screening for the risk and development of cardiovascular disease and diabetes in individuals with an ‘apple shape’ might help to timely prevent to onset of disease, especially in women.”

UK Biobank data

Researchers analyzed data from 479,610 patients (mean age, 56 years; 55% women) aged 40 to 69 years from the UK Biobank between 2006 and 2010. Exclusion criteria included those with a history of CVD or a BMI less than 15 kg/m2 or greater than 60 kg/m2.

Patients completed questionnaires on their medical history, lifestyle and environment, had their functional and physical measurements taken and had urine, blood and saliva samples collected. Physical measurements included hip circumference, waist circumference, height and weight, which were used to calculate BMI, waist-to-hip ratio and waist-to-height ratio.

The study endpoint of interest was fatal or nonfatal MI. Patients were followed up from baseline to March 1, 2016, or to first fatal or nonfatal MI for a median of 7.1 years.

During follow-up, 5,710 patients had an MI, 28% of whom were women. There was an approximate log-linear relationship in men and women between measures of central and general adiposity and the risk for incident MI.

As BMI increased by 1 standard deviation, the HR for MI in women was 1.22 (95% CI, 1.17-1.28) and 1.28 in men (95% CI, 1.23-1.32; P for interaction = .15). The same increase in waist circumference had a stronger association with the risk for MI in women (HR = 1.35; 95% CI, 1.28-1.42) compared with men (HR = 1.28; 95% CI, 1.23-1.33; P for interaction = .048). An increase in waist-to-hip ratio of 1 standard deviation was linked to an HR for MI of 1.36 in men (95% CI, 1.3-1.43) and 1.49 in women (95% CI, 1.39-1.59; P for interaction = .001). This 1 standard deviation increase in waist-to-height ratio was linked to the risk for MI, although it was similar in men (HR = 1.33; 95% CI, 1.28-1.38) and women (HR = 1.34; 95% CI, 1.27-1.4; P for interaction = .38).

The corresponding women-to-men ratio of HRs was 0.96 for BMI (95% CI, 0.91-1.02), 1.07 for waist circumference (95% CI, 1-1.14), 1.15 for waist-to-hip ratio (95% CI, 1.06-1.24) and 1.03 for waist-to-height (95% CI, 0.97-1.09).

Future research

“We need further research to try to disentangle the different ways women and men store body fat and understand how exactly this is linked to different health risks,” Peters said in an interview. “With new imaging techniques, we can measure very precisely where fat is stored. This would help to even differentiate between individuals with an apparently similar body shape and how such differences affect disease risk. Knowing exactly how patterns [of] fat storage influence the risk of obesity-related conditions will yield insights into the biological mechanisms and could inform sex-specific interventions halt the obesity epidemic worldwide.” – by Darlene Dobkowski

For more information:

Sanne A.E. Peters, PhD , can be reached at sanne.peters@georgeinstitute.ox.ac.uk.

Disclosures: The authors report no relevant financial disclosures.

Sanne A.E. Peters

Women with increases in waist-to-hip ratio and waist circumference had a greater risk for MI compared with men, according to a study published in the Journal of the American Heart Association.

Waist-to-hip ratio had a stronger association with the risk for MI vs. BMI, especially in women.

“For doctors and patients, it is important to realize that not only the amount of excess weight, but also body fat distribution matters for their risk of heart disease,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. “Although there are currently no interventions that selectively help to lose excess weight around the waist, more intensive screening for the risk and development of cardiovascular disease and diabetes in individuals with an ‘apple shape’ might help to timely prevent to onset of disease, especially in women.”

UK Biobank data

Researchers analyzed data from 479,610 patients (mean age, 56 years; 55% women) aged 40 to 69 years from the UK Biobank between 2006 and 2010. Exclusion criteria included those with a history of CVD or a BMI less than 15 kg/m2 or greater than 60 kg/m2.

Patients completed questionnaires on their medical history, lifestyle and environment, had their functional and physical measurements taken and had urine, blood and saliva samples collected. Physical measurements included hip circumference, waist circumference, height and weight, which were used to calculate BMI, waist-to-hip ratio and waist-to-height ratio.

The study endpoint of interest was fatal or nonfatal MI. Patients were followed up from baseline to March 1, 2016, or to first fatal or nonfatal MI for a median of 7.1 years.

During follow-up, 5,710 patients had an MI, 28% of whom were women. There was an approximate log-linear relationship in men and women between measures of central and general adiposity and the risk for incident MI.

As BMI increased by 1 standard deviation, the HR for MI in women was 1.22 (95% CI, 1.17-1.28) and 1.28 in men (95% CI, 1.23-1.32; P for interaction = .15). The same increase in waist circumference had a stronger association with the risk for MI in women (HR = 1.35; 95% CI, 1.28-1.42) compared with men (HR = 1.28; 95% CI, 1.23-1.33; P for interaction = .048). An increase in waist-to-hip ratio of 1 standard deviation was linked to an HR for MI of 1.36 in men (95% CI, 1.3-1.43) and 1.49 in women (95% CI, 1.39-1.59; P for interaction = .001). This 1 standard deviation increase in waist-to-height ratio was linked to the risk for MI, although it was similar in men (HR = 1.33; 95% CI, 1.28-1.38) and women (HR = 1.34; 95% CI, 1.27-1.4; P for interaction = .38).

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The corresponding women-to-men ratio of HRs was 0.96 for BMI (95% CI, 0.91-1.02), 1.07 for waist circumference (95% CI, 1-1.14), 1.15 for waist-to-hip ratio (95% CI, 1.06-1.24) and 1.03 for waist-to-height (95% CI, 0.97-1.09).

Future research

“We need further research to try to disentangle the different ways women and men store body fat and understand how exactly this is linked to different health risks,” Peters said in an interview. “With new imaging techniques, we can measure very precisely where fat is stored. This would help to even differentiate between individuals with an apparently similar body shape and how such differences affect disease risk. Knowing exactly how patterns [of] fat storage influence the risk of obesity-related conditions will yield insights into the biological mechanisms and could inform sex-specific interventions halt the obesity epidemic worldwide.” – by Darlene Dobkowski

For more information:

Sanne A.E. Peters, PhD , can be reached at sanne.peters@georgeinstitute.ox.ac.uk.

Disclosures: The authors report no relevant financial disclosures.