Karin Rådholm1,2, John Chalmers2, Toshiaki Ohkuma2,3, Sanne Peters4, Neil Poulter5, Pavel Hamet6, Stephen Harrap7, Mark Woodward2,4,8. 1. Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, Sweden. 2. The George Institute for Global Health, University of New South Wales, Sydney, Australia. 3. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 4. The George Institute for Global Health, University of Oxford, Oxford, UK. 5. International Centre for Circulatory Health, Imperial College, London, UK. 6. Montreal Diabetes Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada. 7. The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia. 8. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Abstract
AIMS: Patients with type 2 diabetes have a high risk of cardiovascular disease (CVD). Central obesity has been particularly associated with this risk relationship. We aimed to evaluate waist to height ratio (WHtR) as a predictor of risk in such patients. METHODS: WHtR was evaluated as a predictor of the risk of CVD and mortality amongst 11 125 participants with type 2 diabetes in the ADVANCE and ADVANCE-ON studies, and was compared with body mass index (BMI), waist circumference and waist hip ratio (WHR). Primary outcome was a composite of death from CVD, non-fatal myocardial infarction or non-fatal stroke. Secondary outcomes were myocardial infarction, stroke, cardiovascular death and death from any cause. Cox models were used, with bootstrapping to compare associations between anthropometric measures for the primary outcome. RESULTS: Median follow-up time was 9.0 years. There was a positive association between WHtR and adverse outcomes. The hazard ratio (HR) (confidence interval), per SD higher WHtR, was 1.16 (1.11-1.22) for the primary endpoint, with no heterogeneity by sex or region, but a stronger effect in individuals aged 66 years or older. The other 3 anthropometric measurements showed similar associations, although there was evidence that WHtR marginally outperformed BMI and WHR. Based on commonly used BMI cut-points, the equivalent WHtR cut-points were estimated to be 0.55 and 0.6, with no evidence of a difference across subgroups. CONCLUSIONS: In patients with diabetes, WHtR is a useful indicator of future adverse risk, with similar effects in different population subgroups.
RCT Entities:
AIMS: Patients with type 2 diabetes have a high risk of cardiovascular disease (CVD). Central obesity has been particularly associated with this risk relationship. We aimed to evaluate waist to height ratio (WHtR) as a predictor of risk in such patients. METHODS: WHtR was evaluated as a predictor of the risk of CVD and mortality amongst 11 125 participants with type 2 diabetes in the ADVANCE and ADVANCE-ON studies, and was compared with body mass index (BMI), waist circumference and waist hip ratio (WHR). Primary outcome was a composite of death from CVD, non-fatal myocardial infarction or non-fatal stroke. Secondary outcomes were myocardial infarction, stroke, cardiovascular death and death from any cause. Cox models were used, with bootstrapping to compare associations between anthropometric measures for the primary outcome. RESULTS: Median follow-up time was 9.0 years. There was a positive association between WHtR and adverse outcomes. The hazard ratio (HR) (confidence interval), per SD higher WHtR, was 1.16 (1.11-1.22) for the primary endpoint, with no heterogeneity by sex or region, but a stronger effect in individuals aged 66 years or older. The other 3 anthropometric measurements showed similar associations, although there was evidence that WHtR marginally outperformed BMI and WHR. Based on commonly used BMI cut-points, the equivalent WHtR cut-points were estimated to be 0.55 and 0.6, with no evidence of a difference across subgroups. CONCLUSIONS: In patients with diabetes, WHtR is a useful indicator of future adverse risk, with similar effects in different population subgroups.
Authors: Ibrahim D Gezawa; Andrew E Uloko; Baffa A Gwaram; Daiyabu A Ibrahim; Ejiofor T Ugwu; Idris Y Mohammed Journal: Diabetes Metab Syndr Obes Date: 2019-12-30 Impact factor: 3.168
Authors: Alexandra K Lee; Mark Woodward; Dan Wang; Toshiaki Ohkuma; Bethany Warren; A Richey Sharrett; Bryan Williams; Michel Marre; Pavel Hamet; Stephen Harrap; John W Mcevoy; John Chalmers; Elizabeth Selvin Journal: J Clin Endocrinol Metab Date: 2020-01-01 Impact factor: 5.958
Authors: Lisa Gensthaler; Daniel M Felsenreich; Julia Jedamzik; Jakob Eichelter; Larissa Nixdorf; Christoph Bichler; Michael Krebs; Bianca Itariu; Felix B Langer; Gerhard Prager Journal: Obes Surg Date: 2022-01-18 Impact factor: 4.129