BMC Public Health. 2026 Oct 2;26(1):2759. doi: 10.1186/s12889-026-29630-0.
ABSTRACT
BACKGROUND: Overweight, (body mass index (BMI), kg/m2) 25-30 and obesity (BMI 30+) have long been linked to an increased risk of myocardial infarction and mortality. To better assess abdominal adiposity, several indices have been developed. However, the risk associated with each index can vary across different populations.
METHODS: This study aims to investigate which body measurement, if any, exhibits the strongest associations with MI, and mortality. In 1993, a cohort of 1,000 randomly selected middle-aged Swedish men participated in a nurse-led health examination. Body measurements were recorded together alongside blood pressure readings, and a fasting blood test was conducted. A follow-up study, spanning 28 years, utilized data from the national Myocardial Infarction Register (Swedeheart) and mortality data from the Swedish Cause of Death Register. The obesity indices included body mass index, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), sagittal abdominal diameter (SAD), and sagittal abdominal diameter-to-height ratio (SADHtR). Cox proportional hazard models were employed to analyze the z-scores of the six body measurements both before and after adjusting for covariates, with outcomes assessed for first-time myocardial infarction (MI) and mortality.
RESULTS: Data were collected for 959 men. Significant correlations were found between the six body measurements, all were associated with cardiovascular disease risk factors, myocardial infarction, and mortality. However, after adjusting for the traditional risk factors, the association with cardiovascular endpoints was diminished or vanished. WHtR emerged as a more reliable indicator, with hazard ratios (HR) of 1.31 (95% CI 1.07-1.62) for myocardial infarction and 1.27 (95% CI 1.08-1.49) for all-cause mortality although the differences were marginal.
DISCUSSION: There is currently no consensus on which obesity indicator should be the preferred predictor of cardiovascular risk. In this study, the WHtR emerged as the more reliable predictor, albeit with marginal clinical significance.
CONCLUSIONS: In this population, after adjustment for traditional risk factors, WHtR proved to be a more reliable predictor for MI and mortality.
PMID:42827246 | DOI:10.1186/s12889-026-29630-0