Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Regional Health - Americas, https://doi.org/10.1016/j.lana.2025.101281 Dr. Thiago Bosco Mendes et al.
Points
- The study evaluated BMI, WC, and WHtR as predictors of CAC incidence among two thousand seven hundred twenty-one participants.
- CAC incidence after a mean of five point two four years was fifteen point five percent, with a ninety-five percent confidence interval of fourteen point two to seventeen percent.
- In unadjusted analysis, all three measures positively associated with CAC incidence, showing various odds ratios per standard deviation.
- Waist-to-height ratio was the only independent predictor of CAC incidence in the fully adjusted model.
- This predictive effect of waist-to-height ratio was primarily observed in individuals with a body mass index below thirty kg/m ².
Summary
This study aimed to evaluate the predictive utility of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in assessing coronary artery calcium (CAC) incidence, a marker of coronary atherosclerosis burden. Analyzing 2,721 participants from the ELSA-Brasil cohort, with a mean age of 48.1 ± 7.56 years and 62.6% females, the research focused on individuals free of cardiovascular disease who initially presented a zero CAC score and underwent repeat testing.
After a mean follow-up of 5.24 years, the incidence of CAC was 15.5% (95% confidence interval [CI]: 14.2–17%). Unadjusted analyses revealed positive associations between BMI, WC, and WHtR with CAC incidence. The odds ratios (OR) per standard deviation were 1.19 (95% CI: 1.08–1.31) for BMI, 1.37 (95% CI: 1.23–1.52) for WC, and 1.39 (95% CI: 1.25–1.54) for WHtR.
In the fully adjusted multivariate logistic regression model, WHtR emerged as the sole independent anthropometric predictor of CAC incidence, with an OR of 1.18 (95% CI: 1.03–1.35) per standard deviation. This predictive effect of WHtR was particularly pronounced and relevant in individuals with a BMI below 30 kg/m ². These findings suggest that WHtR may offer a superior assessment of atherosclerosis risk compared to other anthropometric measures, especially in non-obese populations.
Link to the article: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(25)00292-3/fulltext
References
Mendes, T. B., Generoso, G., Fabiano, R. C., Halpern, B., Janovsky, C. C. P. S., Romero, C. M., Santos, R. D., Bensenor, I., Lotufo, P. A., & Bittencourt, M. S. (2025). Waist-to-height ratio and coronary artery calcium incidence: The Brazilian Longitudinal Study of Adult Health (Elsa-brasil). The Lancet Regional Health - Americas, 101281. https://doi.org/10.1016/j.lana.2025.101281
