Diabetes Metab J.  2016 Feb;40(1):54-61. 10.4093/dmj.2016.40.1.54.

Increased Risk of Progression of Coronary Artery Calcification in Male Subjects with High Baseline Waist-to-Height Ratio: The Kangbuk Samsung Health Study

Affiliations
  • 1Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea.
  • 2Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
  • 3Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. hongsiri@hanmail.net

Abstract

BACKGROUND
The waist-to-height ratio (WHtR) is an easy and inexpensive adiposity index that reflects central obesity. In this study, we examined the association of baseline WHtR and progression of coronary artery calcification (CAC) over 4 years of follow-up in apparently healthy Korean men.
METHODS
A total of 1,048 male participants (mean age, 40.9 years) in a health-screening program in Kangbuk Samsung Hospital, Seoul, Korea who repeated a medical check-up in 2010 and 2014 were recruited. Baseline WHtR was calculated using the value for the waist in 2010 divided by the value for height in 2010. The CAC score (CACS) of each subject was measured by multi-detector computed tomography in both 2010 and 2014. Progression of CAC was defined as a CACS change over 4 years greater than 0.
RESULTS
During the follow-up period, progression of CAC occurred in 278 subjects (26.5%). The subjects with CAC progression had slightly higher but significant baseline WHtR compared to those who did not show CAC progression (0.51+/-0.04 vs. 0.50+/-0.04, P<0.01). The proportion of subjects with CAC progression significantly increased as the baseline WHtR increased from the 1st quartile to 4th quartile groups (18.3%, 18.7%, 28.8%, and 34.2%; P<0.01). The risk for CAC progression was elevated with an odds ratio of 1.602 in the 4th quartile group of baseline WHtR even after adjustment for confounding variables (95% confidence interval, 1.040 to 2.466).
CONCLUSION
Increased baseline WHtR was associated with increased risk for CAC progression. WHtR might be a useful screening tool to identify individuals at high risk for subclinical atherosclerosis.

Keyword

Coronary artery calcification; Progression; Waist-height ratio

MeSH Terms

Adiposity
Atherosclerosis
Confounding Factors (Epidemiology)
Coronary Vessels*
Follow-Up Studies
Humans
Korea
Male*
Mass Screening
Obesity, Abdominal
Odds Ratio
Seoul

Figure

  • Fig. 1 Selection of the participants.

  • Fig. 2 Comparison of the proportion of subjects with coronary artery calcium score (CACS) progression in groups divided according to quartile groups of baseline waist-to-height ratio. ANOVA, analysis of variance.


Cited by  2 articles

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Diabetes Metab J. 2018;42(1):19-25.    doi: 10.4093/dmj.2018.42.1.19.

The Risk of Myocardial Infarction and Ischemic Stroke According to Waist Circumference in 21,749,261 Korean Adults: A Nationwide Population-Based Study
Jung-Hwan Cho, Eun-Jung Rhee, Se-Eun Park, Hyemi Kwon, Jin-Hyung Jung, Kyung-Do Han, Yong-Gyu Park, Hye Soon Park, Yang-Hyun Kim, Soon-Jib Yoo, Won-Young Lee,
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Reference

1. Hu D, Xie J, Fu P, Zhou J, Yu D, Whelton PK, He J, Gu D. Central rather than overall obesity is related to diabetes in the Chinese population: the InterASIA study. Obesity (Silver Spring). 2007; 15:2809–2816.
2. Balkau B, Deanfield JE, Despres JP, Bassand JP, Fox KA, Smith SC Jr, Barter P, Tan CE, Van Gaal L, Wittchen HU, Massien C, Haffner SM. International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Circulation. 2007; 116:1942–1951.
3. Lam BC, Koh GC, Chen C, Wong MT, Fallows SJ. Comparison of body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One. 2015; 10:e0122985.
4. Despres JP, Lemieux I, Prud'homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ. 2001; 322:716–720.
5. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010; 23:247–269.
6. Bielak LF, Rumberger JA, Sheedy PF 2nd, Schwartz RS, Peyser PA. Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata. Circulation. 2000; 102:380–385.
7. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995; 92:2157–2162.
8. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O'Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358:1336–1345.
9. Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Gronemeyer D, Seibel R, Kalsch H, Brocker-Preuss M, Mann K, Siegrist J, Jockel KH. Heinz Nixdorf Recall Study Investigative Group. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010; 56:1397–1406.
10. Yu JH, Yim SH, Yu SH, Lee JY, Kim JD, Seo MH, Jeon WS, Park SE, Park CY, Lee WY, Oh KW, Park SW, Rhee EJ. The relationship of body composition and coronary artery calcification in apparently healthy Korean adults. Endocrinol Metab (Seoul). 2013; 28:33–40.
11. Hyder JA, Allison MA, Wong N, Papa A, Lang TF, Sirlin C, Gapstur SM, Ouyang P, Carr JJ, Criqui MH. Association of coronary artery and aortic calcium with lumbar bone density: the MESA Abdominal Aortic Calcium Study. Am J Epidemiol. 2009; 169:186–194.
12. Okwuosa TM, Greenland P, Ning H, Liu K, Bild DE, Burke GL, Eng J, Lloyd-Jones DM. Distribution of coronary artery calcium scores by Framingham 10-year risk strata in the MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary risk assessment. J Am Coll Cardiol. 2011; 57:1838–1845.
13. Okwuosa TM, Greenland P, Ning H, Liu K, Lloyd-Jones DM. Yield of screening for coronary artery calcium in early middle-age adults based on the 10-year Framingham risk score: the CARDIA study. JACC Cardiovasc Imaging. 2012; 5:923–930.
14. National Glycohemoglobin Standardization Program: List of NGSP certified methods. cited 2016 Jan 20. Available from: http://www.ngsp.org/docs/methods.pdf.
15. Schwartz KL, Monsur JC, Bartoces MG, West PA, Neale AV. Correlation of same-visit HbA1c test with laboratory-based measurements: a MetroNet study. BMC Fam Pract. 2005; 6:28.
16. Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. 1999; 74:243–252.
17. O'Neal WT, Efird JT, Qureshi WT, Yeboah J, Alonso A, Heckbert SR, Nazarian S, Soliman EZ. Coronary artery calcium progression and atrial fibrillation: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging. 2015; 8:e003786.
18. Koulaouzidis G, Charisopoulou D, Maffrett S, Tighe M, Jenkins PJ, McArthur T. Coronary artery calcification progression in asymptomatic individuals with initial score of zero. Angiology. 2013; 64:494–497.
19. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: WHO;1998.
20. Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet. 2004; 363:163.
21. Xu Z, Qi X, Dahl AK, Xu W. Waist-to-height ratio is the best indicator for undiagnosed type 2 diabetes. Diabet Med. 2013; 30:e201–e207.
22. Lee K, Song YM, Sung J. Which obesity indicators are better predictors of metabolic risk?: healthy twin study. Obesity (Silver Spring). 2008; 16:834–840.
23. Hsieh SD, Yoshinaga H. Do people with similar waist circumference share similar health risks irrespective of height? Tohoku J Exp Med. 1999; 188:55–60.
24. Hsieh SD, Yoshinaga H. Is there any difference in coronary heart disease risk factors and prevalence of fatty liver in subjects with normal body mass index having different physiques? Tohoku J Exp Med. 1995; 177:223–231.
25. Hsieh SD, Yoshinaga H. Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women. Intern Med. 1995; 34:1147–1152.
26. Hsieh SD, Yoshinaga H. Abdominal fat distribution and coronary heart disease risk factors in men-waist/height ratio as a simple and useful predictor. Int J Obes Relat Metab Disord. 1995; 19:585–589.
27. Ashwell M, Lejeune S, McPherson K. Ratio of waist circumference to height may be better indicator of need for weight management. BMJ. 1996; 312:377.
28. Lee JS, Aoki K, Kawakubo K, Gunji A. A study on indices of body fat distribution for screening for obesity. Sangyo Eiseigaku Zasshi. 1995; 37:9–18.
29. Soto Gonzalez A, Bellido D, Buno MM, Pertega S, De Luis D, Martinez-Olmos M, Vidal O. Predictors of the metabolic syndrome and correlation with computed axial tomography. Nutrition. 2007; 23:36–45.
30. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005; 56:303–307.
31. Kim MK, Lee WY, Kang JH, Kang JH, Kim BT, Kim SM, Kim EM, Suh SH, Shin HJ, Lee KR, Lee KY, Lee SY, Lee SY, Lee SK, Lee CB, Chung S, Jeong IK, Hur KY, Kim SS, Woo JT. Committee of Clinical Practice Guidelines. Korean Society for the Study of Obesity. 2014 Clinical practice guidelines for overweight and obesity in Korea. Endocrinol Metab (Seoul). 2014; 29:405–409.
32. Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Agudo-Conde C, Rodriguez-Sanchez E, Garcia-Ortiz L. Vasorisk group. Abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive. BMC Cardiovasc Disord. 2012; 12:3.
33. Ge W, Parvez F, Wu F, Islam T, Ahmed A, Shaheen I, Sarwar G, Demmer RT, Desvarieux M, Ahsan H, Chen Y. Association between anthropometric measures of obesity and subclinical atherosclerosis in Bangladesh. Atherosclerosis. 2014; 232:234–241.
34. Budoff MJ, Hokanson JE, Nasir K, Shaw LJ, Kinney GL, Chow D, Demoss D, Nuguri V, Nabavi V, Ratakonda R, Berman DS, Raggi P. Progression of coronary artery calcium predicts all-cause mortality. JACC Cardiovasc Imaging. 2010; 3:1229–1236.
35. Hokanson JE, MacKenzie T, Kinney G, Snell-Bergeon JK, Dabelea D, Ehrlich J, Eckel RH, Rewers M. Evaluating changes in coronary artery calcium: an analytic method that accounts for interscan variability. AJR Am J Roentgenol. 2004; 182:1327–1332.
36. McEvoy JW, Blaha MJ, Defilippis AP, Budoff MJ, Nasir K, Blumenthal RS, Jones SR. Coronary artery calcium progression: an important clinical measurement? A review of published reports. J Am Coll Cardiol. 2010; 56:1613–1622.
37. Houslay ES, Cowell SJ, Prescott RJ, Reid J, Burton J, Northridge DB, Boon NA, Newby DE. Scottish Aortic Stenosis and Lipid Lowering Therapy, Impact on Regression trial Investigators. Progressive coronary calcification despite intensive lipid-lowering treatment: a randomised controlled trial. Heart. 2006; 92:1207–1212.
38. Arad Y, Spadaro LA, Roth M, Newstein D, Guerci AD. Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial. J Am Coll Cardiol. 2005; 46:166–172.
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