Association between waist-hip ratio and coronary artery calcification in postmenopausal women

Many studies have reported that body composition might be associated with cardiovascular disease, but the issue has not been fully investigated in postmenopausal women.

This retrospective study comprised 582 postmenopausal women without a history of cardiovascular disease who visited the Health Promotion Center between May 2008 and February 2018. All women were screened for body fat composition by bioelectrical impedance analysis and for degree of coronary artery calcification (CAC) by multidetector computed tomography. In addition, multivariate analysis, integrated discrimination improvement, and category-free net reclassification improvement were performed.

The level of triglycerides, and the waist-hip ratio (WHR) in participants with CAC (coronary artery calcium score [CACS] > 0) were higher than in participants with a CACS of zero points. When the participants were stratified into four groups according to WHR, participants with CAC (CACS > 0) increased significantly as WHR quartile increased. A multivariate analysis showed that older age (odds ratio [OR]: 2.539; 95% confidence interval [CI]: 1.524-4.230; P < 0.001), triglyceride level (OR: 1.005; 95% CI: 1.002-1.008; P = 0.003), WHR (OR: 1.103; 95% CI: 1.018-1.195; P = 0.017), and history of hypertension (OR: 2.701; 95% CI: 1.715-4.253; P < 0.001) were significantly associated with CAC. The Brier score upon adding WHR to a clinical model was lower than that of the clinical model without WHR. Adding WHR to a clinical model better predicted CAC than a clinical model without WHR (C index: 0.761, 95% CI: 0.724-0.795, P < 0.001; net reclassification improvement: 0.195, P = 0.037; integrated discrimination improvement: 1.02%, P = 0.043).

In asymptomatic postmenopausal women, WHR as measured by bioelectrical impedance analysis was significantly associated with coronary atherosclerosis, supplementing information of usual clinical markers. Hence, WHR might be appropriate as a marker for early atherosclerosis.