Mixed
Abdominal obesity, measured by waist circumference or waist-to-hip ratio, significantly increases the risk of coronary heart disease (CHD), whereas general obesity (BMI ≥30) shows a weaker, non-significant association when analyzed using G-estimation to account for time-varying confounding.
If you are concerned about heart disease risk, waist circumference or waist-to-hip ratio are more accurate predictors than BMI alone. Even if your BMI is in the 'normal' or 'overweight' range, a larger waist circumference (≥102 cm for men, ≥88 cm for women) or higher waist-to-hip ratio indicates a significantly higher risk of coronary heart disease. This risk persists even when accounting for other health factors like blood pressure and cholesterol, suggesting that visceral fat itself is a critical driver of heart disease.
The G-estimated hazard ratios were 1.15 (95% confidence interval (CI): 0.83, 1.47) for general obesity, 1.65 (95% CI: 1.35, 1.92) for AOB based on waist circumference, and 1.38 (95% CI: 1.13, 1.99) for AOB based on waist:hip ratio, suggesting that AOB increased the risk of CHD.
Why this rating
Large prospective cohort (ARIC, n=12,902), long follow-up (median 21.2 years), and use of advanced causal methods (G-estimation) to handle time-varying confounding.
Source
Accounting for Time-Varying Confounding in the Relationship Between Obesity and Coronary Heart Disease: Analysis With G-Estimation
Maryam Shakiba et al. · American Journal of Epidemiology · 2017
DOI 10.1093/aje/kwx360
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