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Abstract：
BACKGROUND: The independent effect of waist-to-height ratio (WHtR) and body fat percentage (BF%) on ischemic cardiovascular disease (CVD) remains uncertain.
OBJECTIVE: This study aimed to investigate the independent associations of WHtR and BF% with ischemic CVD.
METHODS: This prospective cohort study used data from the UK Biobank. BF% was calculated as fat mass divided by body weight, measured by bioimpedance. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for overall and sex-specific associations of BF% and WHtR with risks of ischemic CVD and its main subtypes [myocardial infarction (MI) and ischemic stroke (IS)], adjusted for a range of potential confounders, including mutual adjustment for BF% and WHtR.
RESULTS: In total, 468,333 participants without existing CVD were included in the analysis. During 12 y of follow-up, 20,151 ischemic CVD events, 13,604 MIs, and 6681 ISs were recorded. WHtR was linearly associated with ischemic CVD, MI, and IS, with an HR per 5% increase of 1.23 (95% CI: 1.20, 1.25), 1.24 (95% CI: 1.21, 1.27), and 1.22 (95% CI: 1.18, 1.26), respectively, independent of BF%. A stronger association between WHtR and MI was seen in females than in males. The association of BF% with these outcomes was substantially attenuated in both sexes after adjustment for WHtR. For example, in females, the HR (highest compared with lowest fifth) was reduced from 1.94 (95% CI: 1.76, 2.15) to 1.04 (95% CI: 0.90, 1.01) for ischemic CVD, from 2.04 (95% CI: 1.79, 2.32) to 0.97 (95% CI: 0.81, 1.16) for MI, and from 1.81 (95% CI: 1.54, 2.13) to 1.07 (95% CI: 0.85, 1.33) for IS.
CONCLUSIONS: WHtR, when used as a proxy measure for central obesity, is linearly associated with ischemic CVD in both sexes, which is independent of BF%. In contrast, the relationship of BF% with these health outcomes is predominantly driven by its correlation with WHtR.
OBJECTIVE: This study aimed to investigate the independent associations of WHtR and BF% with ischemic CVD.
METHODS: This prospective cohort study used data from the UK Biobank. BF% was calculated as fat mass divided by body weight, measured by bioimpedance. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for overall and sex-specific associations of BF% and WHtR with risks of ischemic CVD and its main subtypes [myocardial infarction (MI) and ischemic stroke (IS)], adjusted for a range of potential confounders, including mutual adjustment for BF% and WHtR.
RESULTS: In total, 468,333 participants without existing CVD were included in the analysis. During 12 y of follow-up, 20,151 ischemic CVD events, 13,604 MIs, and 6681 ISs were recorded. WHtR was linearly associated with ischemic CVD, MI, and IS, with an HR per 5% increase of 1.23 (95% CI: 1.20, 1.25), 1.24 (95% CI: 1.21, 1.27), and 1.22 (95% CI: 1.18, 1.26), respectively, independent of BF%. A stronger association between WHtR and MI was seen in females than in males. The association of BF% with these outcomes was substantially attenuated in both sexes after adjustment for WHtR. For example, in females, the HR (highest compared with lowest fifth) was reduced from 1.94 (95% CI: 1.76, 2.15) to 1.04 (95% CI: 0.90, 1.01) for ischemic CVD, from 2.04 (95% CI: 1.79, 2.32) to 0.97 (95% CI: 0.81, 1.16) for MI, and from 1.81 (95% CI: 1.54, 2.13) to 1.07 (95% CI: 0.85, 1.33) for IS.
CONCLUSIONS: WHtR, when used as a proxy measure for central obesity, is linearly associated with ischemic CVD in both sexes, which is independent of BF%. In contrast, the relationship of BF% with these health outcomes is predominantly driven by its correlation with WHtR.
摘要：
背景：腰围与身高比（WHtR）和体脂百分比（BF％）对缺血性心血管疾病（CVD）的独立影响仍不确定。
目的：本研究旨在探讨WHtR和BF%与缺血性CVD的独立关联。
方法：这项前瞻性队列研究使用了英国生物银行的数据。BF%计算为脂肪量除以体重，通过生物阻抗测量。Cox模型用95%置信区间(CIs)估计BF%和WHtR与缺血性CVD及其主要亚型[心肌梗死(MI)和缺血性卒中(IS)]风险的总体和性别特异性关联的风险比(HRs)。针对一系列潜在的混杂因素进行了调整，包括BF%和WHtR的相互调整。
结果：总计，468,333名没有心血管疾病的参与者被纳入分析。在12年的随访期间，20,151例缺血性CVD事件，13,604MIs，并记录了6681个ISs。WHtR与缺血性CVD呈线性相关,MI,而且是,每增加5%的HR为1.23(95%CI：1.20，1.25)，1.24（95%CI：1.21，1.27），和1.22（95%CI：1.18，1.26），分别,独立于BF%。女性与男性相比，WHtR和MI之间的关联更强。调整WHtR后，两种性别的BF%与这些结果的相关性均显著减弱。例如,在女性中，缺血性CVD的HR（最高与最低的五分之一）从1.94（95％CI：1.76，2.15）降低到1.04（95％CI：0.90，1.01），MI从2.04(95%CI：1.79，2.32)到0.97(95%CI：0.81，1.16)，IS的1.81（95%CI：1.54，2.13）到1.07（95%CI：0.85，1.33）。
结论：WHtR，当用作中心性肥胖的替代指标时，在两性中都与缺血性CVD线性相关，它独立于BF%。相比之下,BF%与这些健康结局的关系主要由其与WHtR的相关性驱动.
目的：本研究旨在探讨WHtR和BF%与缺血性CVD的独立关联。
方法：这项前瞻性队列研究使用了英国生物银行的数据。BF%计算为脂肪量除以体重，通过生物阻抗测量。Cox模型用95%置信区间(CIs)估计BF%和WHtR与缺血性CVD及其主要亚型[心肌梗死(MI)和缺血性卒中(IS)]风险的总体和性别特异性关联的风险比(HRs)。针对一系列潜在的混杂因素进行了调整，包括BF%和WHtR的相互调整。
结果：总计，468,333名没有心血管疾病的参与者被纳入分析。在12年的随访期间，20,151例缺血性CVD事件，13,604MIs，并记录了6681个ISs。WHtR与缺血性CVD呈线性相关,MI,而且是,每增加5%的HR为1.23(95%CI：1.20，1.25)，1.24（95%CI：1.21，1.27），和1.22（95%CI：1.18，1.26），分别,独立于BF%。女性与男性相比，WHtR和MI之间的关联更强。调整WHtR后，两种性别的BF%与这些结果的相关性均显著减弱。例如,在女性中，缺血性CVD的HR（最高与最低的五分之一）从1.94（95％CI：1.76，2.15）降低到1.04（95％CI：0.90，1.01），MI从2.04(95%CI：1.79，2.32)到0.97(95%CI：0.81，1.16)，IS的1.81（95%CI：1.54，2.13）到1.07（95%CI：0.85，1.33）。
结论：WHtR，当用作中心性肥胖的替代指标时，在两性中都与缺血性CVD线性相关，它独立于BF%。相比之下,BF%与这些健康结局的关系主要由其与WHtR的相关性驱动.
