Adiposidade e risco cardiovascular: razão cintura/altura

J Am Coll Cardiol. 2008 Aug 19;52(8):605-15.
Measures of obesity and cardiovascular risk among men and women.
Gelber RP, Gaziano JM, Orav EJ, Manson JE, Buring JE, Kurth T.
OBJECTIVES: This study examined associations between anthropometric measures (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio [WHtR]) and risk of incident cardiovascular disease (CVD) (including nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death). BACKGROUND: Controversy exists regarding the optimal approach to measure adiposity, and the utility of body mass index has been questioned. METHODS: Participants included 16,332 men in the Physicians' Health Study (mean age 61 years in 1991) and 32,700 women in the Women's Health Study (mean age 61 years in 1999). We used Cox proportional hazards models to determine relative risks and 95% confidence intervals (CIs) for developing CVD according to self-reported anthropometric indexes. RESULTS: A total of 1,505 CVD cases occurred in men and 414 occurred in women (median follow-up 14.2 and 5.5 years, respectively). Although WHtR demonstrated statistically the strongest associations with CVD and best model fit, CVD risk increased linearly and significantly with higher levels of all indexes. Adjusting for confounders, the relative risk for CVD was 0.58 (95% CI: 0.32 to 1.05) for men with the lowest WHtR (<0.45)>/=0.69; vs. WHtR 0.49 to <0.53).>/=0.68; vs. WHtR 0.47 to <0.52).>

Adiposidade e Sobrevida pós Infarto do Miocárdio

Circulation. 2008;118:482-490

Relation Between Body Mass Index, Waist Circumference, and Death After Acute Myocardial Infarction

Marianne Zeller, PhD; Philippe Gabriel Steg, MD, PhD; Jack Ravisy, MD; Luc Lorgis, MD; Yves Laurent, MD; Pierre Sicard, PhD; Luc Janin-Manificat, MD; Jean-Claude Beer, MD; Hamid Makki, MD; Anne-Cécile Lagrost, MSc; Luc Rochette, PharmD, PhD; Yves Cottin, MD, PhD, for the RICO Survey Working Group
Background— An elevated body mass index (BMI) has been reported to be associated with a lower rate of death after acute myocardial infarction (AMI). However, waist circumference (WC) may be a better marker of cardiovascular risk than BMI. We used data from a contemporary French population-based cohort of patients with AMI to analyze the impact of WC and BMI on death rates.
Methods and Results— We evaluated 2229 consecutive patients with AMI. Patients were classified according to BMI as normal, overweight, obese, and very obese (BMI <25,>35 kg/m2, respectively) and as increased waistline (WC >88/102 cm for women/men) or normal. Half of the patients were overweight (n=1044), and one quarter were obese (n=397) or very obese (n=128). Increased WC was present in half of the patients (n=1110). Increased BMI was associated with a reduced death rate, with a 5% risk reduction for each unit increase in BMI (hazard ratio, 0.95; 95% CI, 0.93 to 0.98; P<0.001). In contrast, WC as a continuous variable had no impact on all-cause death (P=0.20). After adjustment for baseline predictors of death, BMI was not independently predictive of death. The group of patients with high WC but low BMI had increased 1-year death rate.
Conclusions— Neither BMI nor WC independently predicts death after AMI. Much of the inverse relationship between BMI and the rate of death after AMI is due to confounding by characteristics associated with survival. This study emphasizes the need to measure both BMI and WC because patients with a high WC and low BMI are at high risk of death.