Research Article| Volume 80, ISSUE 3, P323-328, March 2015

Waist-to-hip ratio is better at predicting subclinical atherosclerosis than body mass index and waist circumference in postmenopausal women


      • In premenopausal women, all anthropometric parameters were significantly correlated with subclinical atherosclerosis.
      • In postmenopausal women, BMI had no significant correlation with subclinical atherosclerosis.
      • In postmenopausal women, WHR was superior to WC for predicting carotid atherosclerosis.
      • Therefore, body fat distribution is more important than simple obesity to predict the risk of CVD in postmenopausal women.



      Body fat distribution becomes more central after menopause. Although some studies have identified the superiority of various anthropometric indices to assess general health outcomes, very limited studies have compared the efficacy of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) to predict subclinical atherosclerosis according to menopausal status.


      In total, 442 participants (209 premenopausal women and 233 postmenopausal women) were prospectively enrolled from the Health Promotion Center of Korea University Guro Hospital. We examined subclinical atherosclerosis using carotid intima-media thickness (CIMT) and brachial-ankle pulse wave velocity (baPWV).


      In premenopausal women, all anthropometric parameters such as BMI, WC and WHR were positively correlated with baPWV and CIMT values, whereas in postmenopausal women, only WHR was positively correlated with baPWV values (0.27, P < 0.01), and WC and WHR were positively correlated with CIMT (0.15, P < 0.05 and 0.21, P < 0.01, respectively). By receiver operating characteristic (ROC) curve analyses, WHR was superior to the other anthropometric indices to predict carotid atherosclerosis in postmenopausal women. Furthermore, the normal weight (BMI < 23 kg/m2) with higher WHR group had a significantly thicker CIMT when compared to the normal weight with lower WHR group (0.76 mm vs. 0.68 mm, P < 0.01) and even the overweight subjects with BMI ≥ 23 kg/m2 (0.76 mm vs. 0.70 mm, P < 0.01) in postmenopausal women.


      The present study shows that WHR has the best potential for predicting subclinical atherosclerosis compared to BMI and WC in postmenopausal women.

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        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • et al.
        Executive summary: heart disease and stroke statistics – 2014 update: a report from the American Heart Association.
        Circulation. 2014; 129: 399-410
        • Carr M.C.
        The emergence of the metabolic syndrome with menopause.
        J Clin Endocrinol Metab. 2003; 88: 2404-2411
        • Despres J.P.
        Body fat distribution and risk of cardiovascular disease: an update.
        Circulation. 2012; 126: 1301-1313
        • Okura T.
        • Nakata Y.
        • Yamabuki K.
        • Tanaka K.
        Regional body composition changes exhibit opposing effects on coronary heart disease risk factors.
        Arterioscler Thromb Vasc Biol. 2004; 24: 923-929
        • Czernichow S.
        • Kengne A.P.
        • Huxley R.R.
        • et al.
        Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type-2 diabetes: a prospective cohort study from ADVANCE.
        Eur J Cardiovasc Prev Rehabil. 2011; 18: 312-319
        • Lim S.
        • Meigs J.B.
        Ectopic fat and cardiometabolic and vascular risk.
        Int J Cardiol. 2013; 169: 166-176
        • Svendsen O.L.
        • Hassager C.
        • Christiansen C.
        Age- and menopause-associated variations in body composition and fat distribution in healthy women as measured by dual-energy X-ray absorptiometry.
        Metabolism. 1995; 44: 369-373
        • Poehlman E.T.
        • Toth M.J.
        • Gardner A.W.
        Changes in energy balance and body composition at menopause: a controlled longitudinal study.
        Ann Intern Med. 1995; 123: 673-675
        • Liu P.
        • Ma F.
        • Lou H.
        • Zhu Y.
        Utility of obesity indices in screening Chinese postmenopausal women for metabolic syndrome.
        Menopause. 2014; 21: 509-514
        • Mancia G.
        • Fagard R.
        • Narkiewicz K.
        • et al.
        2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
        Eur Heart J. 2013; 34: 2159-2219
        • Choi K.M.
        • Lee K.W.
        • Seo J.A.
        • et al.
        Relationship between brachial-ankle pulse wave velocity and cardiovascular risk factors of the metabolic syndrome.
        Diabetes Res Clin Pract. 2004; 66: 57-61
        • Yamashina A.
        • Tomiyama H.
        • Takeda K.
        • et al.
        Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement.
        Hypertens Res. 2002; 25: 359-364
        • Battaglia F.
        • Sevy A.
        • Moyse E.
        • Roche P.H.
        Guillain–Barre syndrome following severe head trauma and spine surgery.
        Rev Neurol (Paris). 2013; 169: 166-168
        • Lovejoy J.C.
        • Champagne C.M.
        • de Jonge L.
        • Xie H.
        • Smith S.R.
        Increased visceral fat and decreased energy expenditure during the menopausal transition.
        Int J Obes (Lond). 2008; 32: 949-958
        • Mathis D.
        Immunological goings-on in visceral adipose tissue.
        Cell Metab. 2013; 17: 851-859
        • Lear S.A.
        • Humphries K.H.
        • Kohli S.
        • Frohlich J.J.
        • Birmingham C.L.
        • Mancini G.B.
        Visceral adipose tissue, a potential risk factor for carotid atherosclerosis: results of the Multicultural Community Health Assessment Trial (M-CHAT).
        Stroke. 2007; 38: 2422-2429
        • Frayn K.N.
        Adipose tissue as a buffer for daily lipid flux.
        Diabetologia. 2002; 45: 1201-1210
        • Yim J.E.
        • Heshka S.
        • Albu J.B.
        • Heymsfield S.
        • Gallagher D.
        Femoral-gluteal subcutaneous and intermuscular adipose tissues have independent and opposing relationships with CVD risk.
        J Appl Physiol (1985). 2008; 104: 700-707
        • Snijder M.B.
        • Visser M.
        • Dekker J.M.
        • et al.
        Low subcutaneous thigh fat is a risk factor for unfavourable glucose and lipid levels, independently of high abdominal fat. The Health ABC Study.
        Diabetologia. 2005; 48: 301-308
        • Snijder M.B.
        • Zimmet P.Z.
        • Visser M.
        • Dekker J.M.
        • Seidell J.C.
        • Shaw J.E.
        Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study.
        Int J Obes Relat Metab Disord. 2004; 28: 402-409
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • et al.
        Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case–control study.
        Lancet. 2005; 366: 1640-1649
        • Fried S.K.
        • Kral J.G.
        Sex differences in regional distribution of fat cell size and lipoprotein lipase activity in morbidly obese patients.
        Int J Obes. 1987; 11: 129-140
        • Foley J.E.
        • Kashiwagi A.
        • Chang H.
        • et al.
        Sex difference in insulin-stimulated glucose transport in rat and human adipocytes.
        Am J Physiol. 1984; 246: E211-E215
        • He H.
        • Ni Y.
        • Chen J.
        • et al.
        Sex difference in cardiometabolic risk profile and adiponectin expression in subjects with visceral fat obesity.
        Transl Res. 2010; 155: 71-77
        • Cooke P.S.
        • Naaz A.
        Role of estrogens in adipocyte development and function.
        Exp Biol Med (Maywood). 2004; 229: 1127-1135
        • Rebuffe-Scrive M.
        • Eldh J.
        • Hafstrom L.O.
        • Bjorntorp P.
        Metabolism of mammary, abdominal, and femoral adipocytes in women before and after menopause.
        Metabolism. 1986; 35: 792-797
        • Rimm E.B.
        • Stampfer M.J.
        • Giovannucci E.
        • et al.
        Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men.
        Am J Epidemiol. 1995; 141: 1117-1127
        • Hwu C.M.
        • Fuh J.L.
        • Hsiao C.F.
        • et al.
        Waist circumference predicts metabolic cardiovascular risk in postmenopausal Chinese women.
        Menopause. 2003; 10: 73-80
        • Paula H.A.
        • Ribeiro Rde C.
        • Rosado L.E.
        • Abranches M.V.
        • Franceschini Sdo C.
        Classic anthropometric and body composition indicators can predict risk of metabolic syndrome in elderly.
        Ann Nutr Metab. 2012; 60: 264-271
        • Price G.M.
        • Uauy R.
        • Breeze E.
        • Bulpitt C.J.
        • Fletcher A.E.
        Weight, shape, and mortality risk in older persons: elevated waist–hip ratio, not high body mass index, is associated with a greater risk of death.
        Am J Clin Nutr. 2006; 84: 449-460
        • Van de Veire N.R.
        • Djaberi R.
        • Schuijf J.D.
        • Bax J.J.
        Non-invasive imaging: non-invasive assessment of coronary artery disease in diabetes.
        Heart. 2010; 96: 560-572

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      • Waist-to-hip ratio as an indicator of atherosclerosis among women at risk
        MaturitasVol. 81Issue 1
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          In a recent article in the Maturitas, Lee et al. reported that waist-to-hip ratio (WHR) had a higher potential for predicting subclinical atherosclerosis compared to other anthropometric indices including body mass index and waist circumference in postmenopausal women [1]. Their study was well designed, sufficiently powered and allowed comparisons to premenopausal women.
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