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Waist size, not BMI, predicts coronary artery disease among women
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Among postmenopausal Korean women with stable chest pain undergoing elective, invasive coronary angiography, central obesity, but not overall obesity, appeared associated with greater likelihood of obstructive coronary artery disease, according to findings published in Menopause.
Jun Hwan Cho, MD, of the department of internal medicine at Seoul National University College of Medicine and Seoul National University Boramae Medical Center in Korea, and colleagues analyzed data from 659 women aged older than 55 years from the Korean Women’s Chest Pain Registry, a database of women with chest pain undergoing elective, invasive coronary angiography. Researchers collected information on traditional risk factors, such as hypertension, diabetes, dyslipidemia and smoking status. They defined obstructive CAD as angiographic findings of at least 50% diameter stenosis of any major epicardial coronary artery. Overall obesity was defined as a BMI of at least 25 kg/m²; central obesity was defined as a waist circumference of at least 85 cm. Researchers used binary logistic regression analysis to determine independent variables associated with obstructive CAD.
Researchers found 311 women (47.2%) had obstructive CAD; these women were older and had more traditional risk factors than those without CAD.
The prevalence of obstructive CAD was not significantly different between women with vs. without overall obesity (44.6% vs. 48.5%); however, the prevalence of obstructive CAD was higher among participants with central obesity than among those without central obesity (55.5% vs. 41%; P < .001). There was no between-group difference in BMI among participants with and without obstructive CAD (mean, 24.6 kg/m vs. 24.8 kg/m²); however, women with obstructive CAD had a larger waist circumference than those without obstructive CAD (mean, 84.7 cm vs. 82.4 cm; P = .001).
In multivariable analysis, researchers found that central obesity was associated with obstructive CAD even after controlling for age, hypertension, diabetes, dyslipidemia and current smoking (OR = 1.61; 95% CI, 1.1-2.34; P = .013). However, overall obesity was not associated with obstructive CAD in the same analysis.
“This result suggests that central obesity, but not overall obesity, may be an independent risk factor for obstructive CAD in postmenopausal women undergoing elective invasive [coronary angiography],” the researchers wrote.
The researchers noted that a change in body composition may be one reason for the increased CAD risk observed among postmenopausal women, as a decline in estrogen level is associated with body fat distribution shifting from gluteofemoral subcutaneous to the abdominal visceral area, a source of cytokine production that contributes to atherosclerotic progression and vascular dysfunction.
“[Waist circumference] is a closer surrogate marker for visceral adiposity, and [waist circumference] has been advocated as a single measure to assess the need for weight reduction, because it reflects both total adiposity and central fat deposition,” the researchers wrote. “BMI is, however, more widely used in the diagnosis of obesity in clinical practice. Considering the more pronounced association of CAD with [waist circumference] rather than BMI, additional [waist circumference] measurements should be suggested especially in elderly women, even though they have normal BMI.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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Cho JH, et al. Menopause. 2019;doi:10.1097/GME.0000000000001392.
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