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Clinical Context
Obesity affects one third of US adults and predisposes
to cardiovascular risk factors including insulin
resistance, hypertension, and dyslipidemia, but it is
unclear whether all the risks can be explained by an
increased burden of atherosclerosis or if other
mechanisms mediate the risk. In addition, BMI has been
used as the primary standard for outcomes of obesity
in studies, alternative measures including WC and WHR
have demonstrated better correlations with
cardiovascular risk than BMI.
Study Highlights
A population-based cohort of 6101 adults aged 18 to 65
years were visited at home for an interview, and 3398
participants aged 30 to 65 years returned for a second
visit for blood and urine tests.
A third visit occurred for 2971 participants who
received a detailed clinical examination,
anthropometric measurements, abdominal MRI for aortic
plaque, and 2 EBCT measurements of CAC.
EBCT scans were performed twice with 40 slices
spanning the entire heart and CAC results averaged and
expressed in Agatston units.
A threshold of 10 Agatston units was used for
diagnosis of atherosclerosis.
Abdominal MRI was performed with 6 total slices of the
infrarenal abdominal aorta, and increased signal
intensity, luminal protrusion, and focal wall
thickening were identified as atherosclerotic plaque.
BMI, WC, hip circumference, and WHR were calculated.
Hypertension was defined as systolic blood pressure of
140 mm Hg or higher, diastolic blood pressure of 90 mm
Hg or higher, or use of antihypertensive medication.
Diabetes was defined by self-report, use of
medications, or fasting glucose levels.
Hypercholesterolemia was defined by use of
lipid-lowering medication or lipid levels for
low-density lipoprotein, total cholesterol, or
triglycerides.
Smoking was defined by smoking cigarettes within 30
days.
Only data were analyzed on participants who completed
all 3 visits with complete imaging data for either
EBCT or MRI.
Participants were divided into sex-specific quintiles
based on BMI, WC, hip circumference, and WHR, and men
and women within each quintile were combined.
Mean age was 45 years, 33% were white, 50% were black,
and 18% were Hispanic.
Mean BMI was 31 kg/m2, 34% had hypertension, mean
systolic blood pressure was 126 mm Hg, and mean
diastolic blood pressure was 78 mm Hg.
12% had diabetes, 25% were current smokers, 12% had
dyslipidemia, and mean total cholesterol was 180
mg/dL.
21% of participants (234 women, 349 men) had
detectable CAC.
The prevalence of CAC increased across quintiles of WC
and WHR, and the odds of prevalent CAC were greater
for each quintile of WC and WHR vs each quintile of
BMI in both men and women.
After adjustment for age, smoking, hypertension,
diabetes, the prevalence of CAC was significantly
increased in the highest quintile of WHR (odds ratio,
1.91; P < .001) but not any quintile of BMI or WC.
WHR consistently predicted CAC compared with either
BMI or WC.
39% of participants (499 women, 477 men) had
detectable aortic plaque.
A 3-fold increase in the prevalence of aortic plaque
was found for the fifth WHR compared with the first
quintiles.
Neither BMI nor WC was significantly associated with
aortic plaque.
WHR demonstrated significantly increased odds for
aortic plaque in the fourth and fifth quintiles.
No positive association was found for BMI or WC for
aortic plaque.
In women, WC less than 88 cm was associated with a
greater prevalence of CAC with higher hip
circumference, but this association was not found in
men.
WHR demonstrated superior discrimination for prevalent
CAC compared with BMI and WC in sex-specific analyses.