Body shape measurements provide clues to heart disease risk

Two simple means of measuring body dimensions can quickly and inexpensively provide information about a person's cardiovascular disease risk, report researchers from Emory and the U.S. Centers for Disease Control and Prevention (CDC) in the September issue of the Journal of Clinical Epidemiology.

"We have confirmed in a North American population that simple body size measurements are highly associated with coronary heart disease," said Henry S. Kahn, associate professor of Family and Preventive Medicine, School of Medicine. "Our case-control comparisons further suggest that the simple combination of measurements best associated with coronary heart disease is not the waist-to-hip ratio (WHR) of circumferences, but rather the abdominal diameter index (ADI) or the waist-to-thigh ratio (WTR). Either the ADI or the WTR provides a continuous variable that might be considered a risk factor for coronary artery disease analogous to blood pressure or lipid levels."

The researchers defined the ADI as the ratio of the front-to-back diameter of the abdomen divided by the circumference of the midthigh.

"The abdominal diameter and midthigh circumference can be measured rapidly with a high level of precision, with no discomfort to the person and at very little cost," Kahn said. "Applied to non-diseased adults drawn from the community, these simple measurements could identify persons with an increased likelihood of future coronary heart disease."

The researchers measured girths of the waist, hips and midthigh; skinfold thicknesses; and abdominal diameter on 217 heart disease patients being hospitalized for their first coronary event (such as a heart attack).

The team then repeated the same measurements on 261 adults without heart disease to determine which simple body measurement indices best identified persons with the new coronary problem. According to the data, heart disease patients were more likely to have high ADI and WTR values than non-diseased adults. In addition, the ADI and WTR values predicted disease risk better than the traditional WHR.

Persons with increased coronary heart disease risk have long been recognized to have an increased WHR, but the WHR has not previously been compared with other anthropometric techniques to see which was the optimal index.

"The ADI is better correlated with coronary heart disease risk," Kahn said, "most likely because the abdominal diameter is a better estimator of the volume of harmful fat located inside the belly. Fat located outside the belly may not be so harmful."

The researchers found that larger thigh measurements and increased subcutaneous fat mass (sum of three skinfolds) were slightly protective against coronary heart disease.

Co-authors of the paper include Harland Austin, public health; David Williamson, CDC; and Daniel Arensberg, medicine.

--Lorri Preston

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