Abstract
BackgroundWe investigated the association of anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and hip circumference (HC) with the risk of incident sudden cardiac death (SCD) among Iranian population with and without type 2 diabetes mellitus (T2DM).MethodsThe study population included 9,089 subjects without and 1,185 subjects with T2DM, aged ≥ 20 years. Participants were recruited in 1999–2001 or 2001–2005, and followed for incident SCD annually, up to 20 March 2018. Multivariate Cox proportional hazard models, adjusted for traditional risk factors of cardiovascular disease, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of anthropometric indices (as continuous and categorical variables).ResultsDuring a follow-up of over 15 years, 144 (1.58%) and 86 (7.26%) incident SCD occurred in non-T2DM and T2DM groups, respectively.Among non-T2DM group, a 1 standard deviation (SD) increase in WHtR was associated with higher risk of incident SCD by a HR of 1.23 (95% CI: 1.00–1.50) in the multivariable model. From the first quartile to the fourth quartile of WHtR, the trend of SCD risk was significant in age- and sex-adjusted analysis (P-value for trend: 0.041). Other indices did not show significant associations with SCD.Among T2DM group, a 1 SD increase in WHR had a HR of 1.36 (1.05–1.76) in the multivariable model. Considering WHR as categorical variables, the trend of SCD risk across quartiles of WHR was significant. Furthermore, a 1 SD increase in HC led to reduced risk of incident SCD with a HR of 0.75 (0.58–0.97) in multivariable analysis; this lower risk remained significant even after adjustment for WC. Compared to the first quartile, the fourth quartile of HC also showed a HR of 0.50 (0.25–0.99) (P-value for trend = 0.018). BMI, WC, and WHtR did not have significant associations with incident SCD.ConclusionIn our long-term population-based study, we demonstrated central but not general obesity (as assessed by WHR in participants with T2DM, and WHtR in participants without T2DM) as a herald of incident SCD. Moreover, HC can have an inverse association with SCD among participants with T2DM.
Highlights
Cardiovascular disease (CVD) is the cause of 18.6 million deaths in 2019 worldwide [1]
A 1 standard deviation (SD) increase in hip circumference (HC) led to reduced risk of incident sudden cardiac death (SCD) with a hazard ratios (HR) of 0.75 (0.58–0.97) in multivariable analysis; this lower risk remained significant even after adjustment for waist circumference (WC)
Yes Family history of premature CVD, yes Prevalent CVD at baseline, yes Lipid-lowering medication, yes Antihypertensive medication, yes BMI body mass index, WC waist circumference, WHR waist-to-hip ratio, WHtR waist-to-height ratio, HC hip circumference, SBP systolic blood pressure, DBP diastolic blood pressure, FPG fasting plasma glucose, CVD cardiovascular disease Values are shown as Mean and number (%) for continuous and categorical variables, respectively *The comparison P-value between two groups was calculated using Student’s two-tailed t-test for continues variables and Chi-square test for categorical variables ⁑Conversion factors from mmol/L to mg/dL were 18.02 for FPG and 38.67 for total cholesterol higher values of SBP, DBP, pulse rate, FPG, and total cholesterol
Summary
Cardiovascular disease (CVD) is the cause of 18.6 million deaths in 2019 worldwide [1]. Coronary heart disease (CHD), with a prevalence of 7.7% among Tehranian adult residents [6], is the structural basis for approximately 70% of all SCD; the majority of CHD-related SCD occurs as the initial manifestation of CHD [7]; this is mainly because a great proportion of individuals experiencing SCD are not categorized into high-risk groups based on stratification of former studies [5, 7, 8]. This issue highlights the need for further investigations to identify the risk factors and high-risk groups for SCD well. We investigated the association of anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and hip circumference (HC) with the risk of incident sudden cardiac death (SCD) among Iranian population with and without type 2 diabetes mellitus (T2DM)
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