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Abstract
Obesity is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, ‘obesity paradox’ is observed in patients with coronary artery disease while defining obesity by body mass index (BMI). The purpose of this study is to identify a better anthropometric parameter to predict cardiovascular events in patients with ASCVD. The study was conducted using the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. A total of 6,920 adult patients with stable ASCVD, enrolled from January 2010 to November 2014, were included, with a mean age of 65.9 years, 73.9% males, and a mean BMI of 26.3 kg/m2 at baseline. These patients were followed up for a median of 2.5 years. The study endpoint was the composite major adverse cardiovascular event (MACE), defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Multivariable Cox proportional hazards regression showed a significant positive association between waist-to-BMI ratio and MACE (adjusted hazard ratio 1.69 per cm‧m2/kg increase in waist-to-BMI ratio, 95% CI 1.12–2.49, p = 0.01) after adjusting for potential risk factors and confounders. Traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, or newer waist-based indices, such as body roundness index and a body shape index, did not show any significant linear associations (p = 0.09, 0.30, 0.89, 0.54, 0.79 and 0.06, respectively). In the restricted cubic spline regression analysis, the positive dose–response association between waist-to-BMI ratio and MACE persisted across all the range of waist-to-BMI ratio. The positive dose–response association was non-linear with a much steeper increase in the risk of MACE for waist-to-BMI ratio > 3.6 cm‧m2/kg. In conclusion, waist-to-BMI ratio may function as a positive predictor for the risk of MACE in established ASCVD patients.
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1 E-Da Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.414686.9) (ISNI:0000 0004 1797 2180); E-Da Dachang Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.414686.9); I-Shou University, School of Medicine, College of Medicine, Kaohsiung, Taiwan (GRID:grid.411447.3) (ISNI:0000 0004 0637 1806)
2 National Taiwan University, Graduate Institute of Clinical Pharmacy and School of Pharmacy, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241); National Taiwan University Hospital, Department of Pharmacy, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
3 E-Da Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.414686.9) (ISNI:0000 0004 1797 2180); I-Shou University, School of Medicine for International Students, College of Medicine, Kaohsiung, Taiwan (GRID:grid.411447.3) (ISNI:0000 0004 0637 1806)
4 National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei City, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815); National Taiwan University College of Medicine, Department and Graduate Institute of Pharmacology, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241)
5 E-Da Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.414686.9) (ISNI:0000 0004 1797 2180)
6 Far Eastern Memorial Hospital, Division of Cardiology, Cardiovascular Medical Center, New Taipei City, Taiwan (GRID:grid.414746.4) (ISNI:0000 0004 0604 4784)
7 Cheng-Hsin General Hospital, Division of Cardiology, Heart Center, Taipei, Taiwan (GRID:grid.413846.c) (ISNI:0000 0004 0572 7890)
8 Mackay Medical College, Mackay Memorial Hospital, Taipei, Taiwan (GRID:grid.452449.a) (ISNI:0000 0004 1762 5613)
9 Taipei Veterans General Hospital, Department of Medical Research and Education, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314)
10 E-Da Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.414686.9) (ISNI:0000 0004 1797 2180); National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei City, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815); National Taiwan University, Graduate Institute of Medical Education and Bioethics, College of Medicine, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241)
11 National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
12 National Cheng Kung University Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan (GRID:grid.412040.3) (ISNI:0000 0004 0639 0054)
13 Taipei Veterans General Hospital, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314)
14 Linkou Chang Gung Memorial Hospital, Division of Cardiology, Department of Internal Medicine, New Taipei City, Taiwan (GRID:grid.454211.7) (ISNI:0000 0004 1756 999X)
15 National Taiwan University Hospital, Division of Cardiovascular Surgery, Department of Surgery, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
16 Hsinchu Mackay Memorial Hospital, Division of Cardiology, Department of Internal Medicine, Hsinchu, Taiwan (GRID:grid.413593.9) (ISNI:0000 0004 0573 007X)
17 Taipei Veterans General Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314)
18 National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei City, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
19 Hualien Tzu Chi Hospital, Division of Cardiology, Department of Internal Medicine, Hualien, Taiwan (GRID:grid.412094.a)
20 Far Eastern Memorial Hospital, Division of Cardiovascular Surgery, Cardiovascular Medical Center, New Taipei City, Taiwan (GRID:grid.414746.4) (ISNI:0000 0004 0604 4784)
21 National Taiwan University Hospital, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
22 National Taiwan University Hospital, Department of Neurology, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
23 Kaohsiung Medical University Chung-Ho Memorial Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.412027.2) (ISNI:0000 0004 0620 9374)
24 Chi Mei Memorial Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan (GRID:grid.412094.a)
25 China Medical University Hospital, Division of Cardiology, Department of Internal Medicine, Taichung, Taiwan (GRID:grid.411508.9) (ISNI:0000 0004 0572 9415)