Individuals with normal BMI but middle-high or very-high waist-to-height ratio trajectories had a higher risk of incident CHD compared to double-normal trajectories (HR 1.43; 95% CI 1.02-2.00).
Cohort (n=5,164)
Do trajectories of waist-to-height ratio and BMI over a decade predict incident coronary heart disease in adults?
Routine monitoring of waist-to-height ratio alongside BMI provides better risk stratification for incident coronary heart disease than BMI alone.
Hazard Ratio: 1.43 (95% CI 1.02–2)
Abstract Background Individuals with a high body mass index (BMI) are at an increased risk of coronary heart disease (CHD). However, some studies suggest that waist-based measures, such as the waist-to-height ratio (WHtR), may provide a more accurate assessment of CHD risk. Compared to a single measurement, trajectories of adiposity indices over time can better reflect changes in weight or waist circumstances and their cumulative health effects. Purpose We aim to describe the dual trajectories of BMI and WHtR over a decade in the UK adult population and combine these trajectories to explore the associations between adiposity index trajectories and incident CHD. Methods Three repeated measures of BMI and WHtR were collected over a decade (Phase 3 - Phase 7, 1991-2004) in 5,164 participants without CHD from the Whitehall II cohort study of British civil servants. We applied group-based trajectory modeling (GBTM) to classify individuals into separate BMI and WHtR trajectory groups, and subjects were then followed up for incident CHD until 2013. We examined the prospective associations between dual trajectories of BMI and WHtR and incident CHD by Cox regression analysis. Results The mean baseline (Phase 7) age was 60.7 years, with 28.5% of participants being female and 93.5% White. There were 452 incident CHD cases after a median follow-up of 10.1 years. GBTM separately identified three trajectory groups for BMI and WHtR, using the normal-level group as the reference, where the average trajectory remained within the normal range (BMI25 kg/m²; WHtR0.5). HRs for the WHtR middle-high and very-high groups were 1.44 (95% CI: 1.09–1.92) and 1.83 (95% CI: 1.30–2.59), respectively, while for BMI, the corresponding HRs were 1.38 (95% CI: 1.12–1.70) and 1.43 (95% CI: 1.10–1.86). In the combined analysis, 58.7% of individuals in the BMI normal-level group (n = 2,729) were also in the WHtR middle-high or very-high group, with an HR of 1.43 (95% CI: 1.02–2.00) for CHD risk versus the double-normal group. Conversely, only 3.6% in the WHtR normal-level group (n = 1,170) were in the BMI middle-high or very-high group, with no significant difference in CHD risk compared to the double-normal group. Conclusion Routine WHtR monitoring in general practice may provide greater benefits than BMI management alone for CHD prevention. When assessing individual obesity-related CHD risk, using both BMI and WHtR is preferable.
Huang et al. (2025) conducted a cohort in Coronary heart disease (n=5,164). Dual trajectories of body mass index (BMI) and waist-to-height ratio (WHtR) vs. Double-normal trajectory group (BMI<25 kg/m²; WHtR<0.5) was evaluated on Incident coronary heart disease (HR 1.43, 95% CI 1.02-2.00). Individuals with normal BMI but middle-high or very-high waist-to-height ratio trajectories had a higher risk of incident CHD compared to double-normal trajectories (HR 1.43; 95% CI 1.02-2.00).