The highest waist-to-height ratio quartile was associated with an increased risk of composite CVD events compared to the lowest quartile in patients with OSA and CVD (HR 1.50; 95% CI 1.12-2.02).
RCT (n=2,662)
Yes
Does central adiposity (measured by waist-to-height ratio) predict recurrent cardiovascular events better than BMI in patients with established cardiovascular disease and obstructive sleep apnea?
Central adiposity, measured by waist-to-height ratio, is a stronger predictor of recurrent cardiovascular events than BMI in patients with established CVD and obstructive sleep apnea.
Effect estimate: HR 1.50 (95% CI 1.12-2.02)
p-value: p=0.0221
Abstract Background and aims Obesity is a key risk factor underlying both obstructive sleep apnea (OSA) and cardiovascular disease (CVD). To determine differential strength of associations of adiposity indices with recurrent CVD events in patients with established CVD and OSA. Methods Post-hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants with moderate-to-severe OSA and established CVD were randomized to usual care plus continuous positive airway pressure (CPAP) treatment or usual care alone. Cox proportional hazards models were used to evaluate associations of adiposity indices of body-mass index (BMI) and waist-to-height ratio (WHtR), and the future risk of composite CVD events. Results Of 2662 OSA participants with established CVD, 846 (31.8%) were obese by BMI (≥30 kg/m2), while 2544 (95.6%) had central adiposity (WHtR ≥0.5). Over a 3.7-year follow-up, no clear association was found between BMI-defined overweight/obesity and the composite CVD endpoint. However, a significant linear association was evident for WHtR (P for linearity 0.0221) and the composite CVD endpoint. The highest WHtR quartile had a 1.50-fold increased risk of composite CVD events (HR 1.50, 95% CI 1.12-2.02) compared to the lowest quartile. There was no heterogeneity in the effect of CPAP treatment on composite CVD events or CPAP adherence by any baseline adiposity measures. Conclusions In this large trial of adults with co-occurring OSA and CVD, nearly all had central adiposity (assessed with WHtR) which was associated with heightened risk of future CVD events, whereas the conventional measure of BMI had no clear prognostic significance. Conflict of interest Dr You holds the National Natural Science Foundation of China (82471226), Discipline Construction Program of the Second Affiliated Hospital of Soochow University (XKTJ-XK202401 and XKTJ-RC202412). Dr Anderson holds a the National Health and Medical Research Council (NHMRC) of Australia Senior Investigator Fellowship and reports grant funding from NHMRC, Penumbra, and Takeda China. The other authors have nothing to disclose.
You et al. (2026) conducted an RCT in Obstructive sleep apnea and established cardiovascular disease (n=2,662). Highest waist-to-height ratio (WHtR) quartile vs. Lowest WHtR quartile was evaluated on Composite CVD events (HR 1.50, 95% CI 1.12-2.02, p=0.0221). The highest waist-to-height ratio quartile was associated with an increased risk of composite CVD events compared to the lowest quartile in patients with OSA and CVD (HR 1.50; 95% CI 1.12-2.02).