Large waist circumference increases recurrent event risk after MI
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Abdominal obesity was common in patients post-MI, and a larger waist circumference in this population was independently linked with recurrent atherosclerotic CVD, especially in men, according to a study published in the European Journal of Preventive Cardiology.
“The reason that abdominal obesity is so dangerous is that it is closely associated with conditions that accelerate the clogging of arteries,” Hanieh Mohammadi, MD, doctor in the department of clinical sciences and education at Karolinska Institute-Södersjukhuset in Stockholm, told Healio. “However, in our study, we see that increasing abdominal obesity was independently associated with recurrent heart attacks and strokes regardless of … risk factors and medications used to counteract them. This suggests that there are more negative mechanisms with abdominal obesity that are yet unknown.”
Researchers analyzed data from 22,882 patients (16,950 men; mean waist circumference in men, 101.3 cm; mean waist circumference in women, 94.1 cm) aged 35 to 77 years from the SWEDEHEART registry who had an MI as their first manifestation of ASCVD. Patients had a waist circumference measurement during a follow-up visit between 4 weeks and 10 weeks after their first MI. A follow-up visit was also conducted between 12 weeks and 14 weeks after MI.
During both follow-up visits, data on CV risk factors and other information were collected including smoking, diet, physical activity, employment status and quality of life. Other measurements taken during the visits were BP, weight, height, waist circumference, lipids and ECG rhythm.
The primary outcome was recurrent ASCVD, defined as CHD death, nonfatal MI or fatal or nonfatal ischemic stroke.
A recurrent ASCVD event occurred in 7.3% of men and 7.9% of women during a median follow-up of 3.8 years.
Waist circumference and risk
Compared with the first quintile of waist circumference, those in the fifth quintile had an increased risk for a recurrent event in a univariate analysis (HR = 1.22; 95% CI, 1.07-1.39). In a multivariable adjusted analysis, patients in the fourth (HR = 1.21; 95% CI, 1.03-1.43) and fifth quintiles (HR = 1.25; 95% CI, 1.04-1.5) had increased risk compared with those in the first quintile.
The relationship between waist circumference and recurrent ASCVD was similar in men to the main results for the fourth and fifth quintiles. There was a U-shaped association in women, as the lowest risk was observed in the middle quintile. In an analysis in which patients were stratified by BMI, there was also a U-shaped association in which overweight patients had the lowest risk compared with underweight, normal-weight and obese patients.
“We recommend that doctors and nurses measure waist circumference in clinical settings to identify first-time heart attack patients at increased risk of recurrent events,” Mohammadi said in an interview.
Necessary statistical power
Daniel Matos, MD, cardiologist at Hospital de Santa Cruz in Lisbon, Portugal, and Daniel Matos and António M. Ferreira, MD, of the department of cardiology at Hospital de Santa Cruz, wrote a related editorial that “There is comfort in numbers, and this large population provides the necessary statistical power for the necessary adjustment for a myriad of ASCVD risk factors and potential confounders.” – by Darlene Dobkowski
For more information:
Hanieh Mohammadi, MD, can be reached at hanieh.mohammadi@sll.se.
Disclosures: Mohammadi and the editorial authors report no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.
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