Anthropometric assessment of abdominal obesity and coronary heart disease risk in men : the PRIME study

Elise Gruson ¹, Michèle Montaye ¹, Frank Kee ², Aline Wagner ³, Annie Bingham ⁴, Jean-Bernard Ruidavets ⁵, Bernadette Haas ³, Alun Evans ², Jean Ferrières ⁵, Pierre Ducimetière ⁴, Philippe Amouyel ¹ and Jean Dallongeville ^1*

¹ Institut Pasteur de Lille, France
² Queen's University, United Kingdom
³ Université Louis Pasteur, France
⁴ INSERM, France
⁵ Faculté de Médecine Purpan, France

^* To whom correspondence should be addressed. E-mail: jean.dallongeville{at}pasteur-lille.fr.

Accepted 10 June 2009

Abstract

Objective: Waist-to-height ratio is an anthropometric indicator of abdominal obesity that accounts for stature. Earlier studies have reported marked associations between the waist-to-height ratio and cardiovascular risk factors. The goal of this study was to compare the associations of waist-to-height ratio, waist girth or waist-to-hip ratio and coronary events incidence.

Design: Prospective study with 10,602 men, aged 50 to 59 years old, recruited between 1991 and 1993 in 3 centres in France and 1 centre in Northern Ireland. Clinical and biological data were obtained at interview by trained staff. During the 10 years of follow-up 659 incident coronary events (CHD) were recorded. The relationships between anthropometric markers and coronary events were estimated by Cox proportional hazards models.

Results: Waist circumference, waist-to-hip ratio and waist-to-height ratios were positively associated with blood pressure (p<0.0001), diabetes (p<0.0001), LDL-cholesterol (p<0.0001), triglycerides (p<0.0001) and inversely correlated to HDL-cholesterol (p<0.0001). There was a linear association between waist circumference, waist-to-hip ratio and waist-to-height ratio and CHD events. The age and centre-adjusted relative risk [95% CI] for CHD were 1.57 [1.22-2.01], 1.75 [1.34-2.87], 2.3 [1.79-2.99] and 1.99 [1.54-2.56] in the 5th quintile vs. the first quintile of waist circumference, waist-to-hip ratio, waist-to-height ratio and BMI distribution, respectively. After further adjustment for school duration, physical activity, tobacco and alcohol consumption, hypertension, diabetes, HDL-cholesterol and triglycerides, the relative risks for CHD were 0.99 [0.76-1.30] for waist circumference (p=0.5), 1.22[0.93-1.60] for waist-to-hip ratio (p=0.1), 1.53[1.16-2.01] for waist-to-height ratio (p=0.03) and 1.30 [0.99-1.71] for BMI (p=0.06).

Conclusion: In middle-aged European men, waist-to-height ratio identifies coronary risk more strongly than waist circumference, waist-to-hip ratio or BMI, though the difference is marginal.