【論文摘要】The Waist-to-Body Mass Index Ratio is a Better Predictor for Cardiovascular Outcome in Patients with Established Atherosclerotic Cardiovascular Disease - No U-shaped Phenomenon

Chin-Feng Hsuan ； Fang-Ju Lin ； Wei-Kung Tseng ； Wei-Hsian Yin ； Hung-I Yeh ； Jaw-Wen Chen ； Chau-Chung Wu

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 126-126

https://doi.org/10.6907/SCJ.201909/SP_1(2).0101

摘要

Background/Synopsis: Obesity appears to be an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, many studies have observed an 'obesity paradox' in patients with established coronary artery disease, in which the body mass index (BMI)-mortality curve is U-shaped. Objectives/Purpose: To search a better anthropometric parameter to predict the cardiovascular events in patients with ASCVD. Methods/Results: The study was conducted from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. Adult patients with stable ASCVD were enrolled. The primary composite endpoint of this study is the time of the first major cardiovascular event, defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Dose response association between primary outcome events and various traditional anthropometric parameters, including weight, BMI, waist and waist-hip ratio, and a new parameter, the waist-to-BMI ratio, was examined using the Cox proportional hazards regression model. We used restricted cubic spline regression to investigate the potential nonlinear relationship between each anthropometric measure and primary outcome events, and the likelihood ratio test was used to test for nonlinearity. A total of 6921 patients with ASCVD, enrolled from January, 2010 to November, 2014, were included in this analysis, with a mean age of 65.9 ± 11.7 years, 73.9% males and a mean BMI of 26.3 ± 3.8 kg/m2 at baseline. These patients were followed up for a median of 2.5 years. Multivariable Cox proportional hazards regression showed a significant positive association between the waist-to-BMI ratio and the primary outcome events (adjusted hazard ratio 1.67 per cm．m2/kg increase in waist-to-BMI ratio, 95% CI 1.12-2.49, p = 0.01) after adjusted for potential risk factors and confounders. Other traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, did not showed significant associations (p = 0.10, 0.31, 0.90, and 0.52, respectively). In the restricted cubic spline regression, the positive dose response association between the primary outcome events and the waist-to-BMI ratio persisted across all the waist-to-BMI ratio, without a U-shaped phenomenon that was observed in associations with other traditional anthropometric parameters. The positive dose response association was non-linear between the waist-to-BMI ratio and the primary outcome events (the test for nonlinearity was statistically significant, p ＜ 0.001) with a much steeper increase in the major cardiovascular event for the waist-to-BMI ratio ＞ 3.6 cm．m2/kg. Conclusion: This study found the waist-to-BMI ratio to be a better predictor for major adverse cardiovascular events in established ASCVD patients than other traditional anthropometric parameters.