Central adiposity outperforms body mass index in predicting coronary artery disease: a prospective comparative study
G Abreu, M Mendonca, F Sousa, M Ferreira, F Escorcio Silva, E Henriques, S Freitas, M Rodrigues, S Borges, I Ornelas, A Drumond, A C Sousa, R Palma dos ReisAbstract
Obesity is a well-established risk factor for coronary artery disease (CAD). Increasing evidence, however, indicates that obesity should not be regarded solely as a risk factor but as a chronic, multifactorial disease with complex metabolic and inflammatory consequences. A recent Commission (2025) proposed redefining obesity beyond reliance on body mass index (BMI), recommending integrating BMI with additional anthropometric indices that better capture adipose tissue distribution and cardiometabolic risk. These developments reinforce the need to identify which anthropometric markers more accurately reflect obesity-related cardiovascular risk.
To compare three anthropometric indexes—waist-to-height ratio (WHtR), BMI, and waist-to-hip ratio (WHR)—in their association with CAD and determine which index performs best in our population.
We conducted a prospective study including 3,157 individuals classified into CAD and non-CAD groups. Student’s t-tests assessed differences between groups. ROC curves and pairwise AUC comparisons were performed using DeLong’s test. Multivariable logistic regression models were constructed for each index, adjusted for sex, age, diabetes, dyslipidaemia, hypertension, smoking, sedentary lifestyle, and alcohol intake (>300 g/week).
All anthropometric indexes were significantly higher in CAD patients: WHtR (p<0.0001), BMI (p=0.001), and WHR (p<0.0001). WHtR showed an AUC of 0.599 (95% CI: 0.582–0.617), BMI an AUC of 0.545 (95% CI: 0.527–0.562), and WHR an AUC of 0.604 (95% CI: 0.587–0.621). Pairwise comparisons showed significant differences between WHtR and BMI (ΔAUC=0.055; p<0.0001) and between BMI and WHR (ΔAUC=0.060; p<0.0001), with no significant difference between WHtR and WHR (ΔAUC=0.005; p=0.605). In adjusted regression, WHtR was associated with CAD (OR=4.05; p=0.036), WHR showed a strong association (OR=16.71; p<0.0001), and BMI demonstrated an inverse association (OR=0.98; p=0.020).
Anthropometric indexes were associated with CAD, with central-adiposity measures showing the strongest associations. These indexes are simple to calculate and apply in routine practice. They may help identify individuals at higher risk of CAD, allowing preventive measures to be implemented promptly.Central Adiposity Outperformes BMI