Superiority of waist circumference and body mass index in cardiovascular risk assessment in hypertensive patients with coronary heart disease

Introduction: It has been reported in coronary heart disease (CHD) patients that mortality is inversely associated with body mass index (BMI), and directly associated with waist circumference (WC). The purpose of this study was to examine the association of the general obesity parameter (BMI) and the adipose tissue discriminator (WC) with cardiovascular (CV) risk in patients with CHD established by coronary angiography.

Objectives: 1345 subjects with CHD were included in the PROGNOSIS (Prognostic Value of Ambulatory Blood Pressure Monitoring in Patients with Coronary Artery Disease Confirmed by Angiography) study.

Patients and methods: A multivariate Cox proportional regression model adjusted for potential confounders was used to assess the relative risk of total and CV mortality according to the parameters of general obesity (BMI) and adipose tissue distribution (WC).The mean age of subjects was 63.2 ± 9.2 years, and 57% were men. Results. There was direct relationship between WC and both total mortality [hazard ratio, HR = 1.03 (95% CI 1.01-1.10), p < 0.01] and CV mortality [HR = 1.03 (95% CI 1.01-1.07), p < 0.03], but an inverse relationship between BMI and both total mortality [HR = 0.91 (95% CI 0.86-0.98), p < 0.03] and CV mortality [HR = 0.97 (95% CI 0.87-0.99), p < 0.05]. After combining WC with BMI, the group of subjects with BMI < 25 kg/m(2) and WC ≥ 104 cm had the highest rates of both total and CV mortality of all CHD patients.

Conclusions: Assessment based on a combination of WC and BMI is superior to assessment based on a separate estimation of these parameters in both total and CV mortality risk evaluation.