Clinical Research
Atherosclerosis
The Association of Differing Measures of Overweight and Obesity With Prevalent Atherosclerosis: The Dallas Heart Study

https://doi.org/10.1016/j.jacc.2007.04.066Get rights and content
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Objectives

This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort.

Background

Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic burden.

Methods

Using data from the Dallas Heart Study, we assessed the association between gender-specific obesity measures (i.e., body mass index [BMI]; waist circumference [WC]; waist-to-hip ratio [WHR]) and prevalent atherosclerosis defined as coronary artery calcium (CAC) score >10 Agatston units measured by electron-beam computed tomography and detectable aortic plaque measured by magnetic resonance imaging.

Results

In univariable analyses (n = 2,744), CAC prevalence was significantly greater only in the fifth versus first quintile of BMI, whereas it increased stepwise across quintiles of WC and WHR (p trend <0.001 for each). After multivariable adjustment for standard risk factors, prevalent CAC was more frequent in the fifth versus first quintile of WHR (odds ratio 1.91, 95% confidence interval 1.30 to 2.80), whereas no independent positive association was observed for BMI or WC. Similar results were observed for aortic plaque in both univariable and multivariable-adjusted analyses. The c-statistic for discrimination of prevalent CAC was greater for WHR compared with BMI and WC in women and men (p < 0.001 vs. BMI; p < 0.01 vs. WC).

Conclusions

We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.

Abbreviations and Acronyms

BMI
body mass index
CAC
coronary artery calcium
EBCT
electron-beam computed tomography
HC
hip circumference
HDL
high-density lipoprotein
MRI
magnetic resonance imaging
OR
odds ratio
WC
waist circumference
WHR
waist-to-hip ratio

Cited by (0)

This study was funded by the Donald W. Reynolds Foundation (Las Vegas, Nevada) and was partially supported by USPHS GCRC grant #M01-RR00633 from NIH/NCRR-CR. See accompanying online Cardiosource Slide Set.

1

Drs. de Lemos and See had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.