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Mayo Clin Proc. 2016 Mar;91(3):343-51. doi: 10.1016/j.mayocp.2015.12.007. Epub 2016 Feb 6.

Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease.

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Division of Cardiovascular Diseases, Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH; Centers for Health and Aging and the Health Promotion Research Center at Dartmouth, Dartmouth College, Hanover, NH.
Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic.
Department of Cardiology, Herlev University Hospital of Copenhagen, Denmark.
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.
Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Bourgogne-Franche-Comté, Dijon, France.
Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Department of Health, Science and Technology, Aalborg University, Denmark.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Electronic address:



To study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD).


We identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality.


Patients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24).


In older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment.

[Indexed for MEDLINE]

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