Waist-to-hip Ratio Better Than BMI at Determining Obesity-related MI Risk

NEW YORK (Reuters Health) - As a measure of obesity, the waist-to-hip ratio is a better predictor of MI risk than the more commonly used BMI, according to a report in the November 5th issue of The Lancet. "The main message from the new...report is that current practice with BMI as the measure of obesity is obsolete, and results in considerable underestimation of the grave consequences of the overweight epidemic," Dr. Charlotte Kragelund, from Akershus University, and Dr. Torbjorn Omland, from the University of Oslo, both in Norway, comment in a related editorial. The findings are based on a comparison of BMI and waist-to-hip ratio in predicting MI in 12,461 case patients and 14,637 controls drawn from 52 countries and representing several major ethnic groups. Consistent with previous reports, Dr. Salim Yusuf, from McMaster University in Hamilton, Ontario, and colleagues found that the risk of MI increased as BMI rose. However, after accounting for waist-to-hip ratio and other risk factors, the association was no longer statistically significant. By contrast, waist-to-hip ratio predicted MI risk, and the correlation remained significant on multivariate analysis. The risk of MI increased progressively as waist-to-hip ratio climbed with subjects in the highest quintile being 75% more likely to experience an MI than those in the lowest quintile (p < 0.0001). The top two quintiles of waist-to-hip ratio accounted for 24.3% of the population-attributable risks of MI, whereas the top two quintiles of BMI only accounted for 7.7%. "Use of raised weight-to-hip ratio as the index of obesity instead of BMI increases the population attributable risk for myocardial infarction threefold," the authors state. "Our findings suggest that substantial reassessment is needed of the importance of obesity for cardiovascular disease in most regions of the world."

Lancet 2005;366:1589-1591,1640-1648.

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