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CLINICAL RESEARCH: ATHEROSCLEROSIS

The Association of Differing Measures of Overweight and Obesity With Prevalent Atherosclerosis

The Dallas Heart Study

Raphael See, MD^_*,1, Shuaib M. Abdullah, MD^_*, Darren K. McGuire, MD, MHSc, FACC^_*,, Amit Khera, MD, MSc, FACC^_*,, Mahesh J. Patel, MD^_*, Jason B. Lindsey, MD^_*, Scott M. Grundy, MD, PhD and James A. de Lemos, MD, FACC^_*,,1,_*

^_* Division of Cardiology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Texas
Donald W. Reynolds Cardiovascular Clinical Research Center, the University of Texas Southwestern Medical Center, Dallas, Texas.

Manuscript received January 29, 2007; revised manuscript received March 23, 2007, accepted April 1, 2007.

^_* Reprint requests and correspondence: Dr. James A. de Lemos, University of Texas Southwestern Medical Center at Dallas, 5909 Harry Hines Boulevard, HA 9.133, Dallas, Texas 75390-9037. (Email: James.deLemos{at}UTSouthwestern.edu).

Objectives: This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort.

Background: Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic burden.

Methods: Using data from the Dallas Heart Study, we assessed the association between gender-specific obesity measures (i.e., body mass index [BMI]; waist circumference [WC]; waist-to-hip ratio [WHR]) and prevalent atherosclerosis defined as coronary artery calcium (CAC) score >10 Agatston units measured by electron-beam computed tomography and detectable aortic plaque measured by magnetic resonance imaging.

Results: In univariable analyses (n = 2,744), CAC prevalence was significantly greater only in the fifth versus first quintile of BMI, whereas it increased stepwise across quintiles of WC and WHR (p trend <0.001 for each). After multivariable adjustment for standard risk factors, prevalent CAC was more frequent in the fifth versus first quintile of WHR (odds ratio 1.91, 95% confidence interval 1.30 to 2.80), whereas no independent positive association was observed for BMI or WC. Similar results were observed for aortic plaque in both univariable and multivariable-adjusted analyses. The c-statistic for discrimination of prevalent CAC was greater for WHR compared with BMI and WC in women and men (p < 0.001 vs. BMI; p < 0.01 vs. WC).

Conclusions: We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.

Abbreviations and Acronyms   BMI = body mass index   CAC = coronary artery calcium   EBCT = electron-beam computed tomography   HC = hip circumference   HDL = high-density lipoprotein   MRI = magnetic resonance imaging   OR = odds ratio   WC = waist circumference   WHR = waist-to-hip ratio

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