The Waist-to-Height Ratio and Incidence of High LDL Cholesterol in Japanese: A Retrospective Cohort Study

Low-density lipoprotein cholesterol (LDL-C) is a major contributor to atherosclerotic cardiovascular disease (CVD). The waist-to-height ratio (WHtR) has been proposed as a practical marker of central obesity; however, evidence linking WHtR with incident high LDL-C levels in Japanese populations remains limited. This study investigated the association between WHtR and future LDL-C elevation in a community-based cohort in Japan.

This retrospective cohort study included 3,934 adults aged 30-74 years without dyslipidemia at baseline from the Iki Epidemiological Study of Atherosclerosis and Chronic Kidney Disease. The participants were followed between 2008 and 2019. WHtR was categorized into sex-specific quartiles. Incident high LDL-C was defined as LDL-C ≥ 3.62 mmol/L or initiation of lipid-lowering therapy. Cox proportional hazards models were used to estimate the hazard ratios (HRs), after adjusting for demographic, lifestyle, and clinical factors.

During a mean follow-up period of 5.02 years, 466 females and 424 males developed high LDL-C levels. Among females, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for quartile 4 versus quartile 1 was 1.95 (1.41-2.71; p for trend ＜0.0001). Among males, the corresponding adjusted HR (95% CI) was 1.61 (1.18-2.21; p for trend = 0.001). A higher WHtR was associated with an increased risk of incident high LDL-C in both sexes (trend p＜0.01). A WHtR threshold of approximately 0.5 corresponded to a notable increase in risk.

A Higher WHtR was associated with an increased risk of incident high LDL-C. These findings suggest that WHtR may be a useful anthropometric indicator for identifying individuals at risk, although further studies are required.