Measures of obesity and first atherosclerotic cardiovascular events in stage 0 cardiovascular-kidney-metabolic syndrome: Tehran lipid and glucose study

To investigate the association between obesity measures and the risk of incident atherosclerotic cardiovascular disease (ASCVD) among adults at cardiovascular-kidney-metabolic syndrome (CKM) stage 0 in a Middle Eastern population. Data were obtained from 691 adults (47.6% women; mean [SD] age, 40.4 [10.4] years) in the Tehran Lipid and Glucose Study who were free of CKM risk factors and were followed for a median of 19.6 years. Associations of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) with incident ASCVD were assessed using Cox proportional hazards models and restricted cubic spline analyses. During follow-up, 58 participants (8.4%) developed ASCVD. Linear dose–response relationships were observed between WC, WHtR, and WHR and incident ASCVD risk (all P for non-linearity >0.3). After adjustment for education level and the PREVENT 10-year total CVD risk score, the HRs (95% CIs) per 1 kg/m 2 higher BMI, 5 cm higher WC, 0.05 higher WHtR, and 0.05 higher WHR were 1.15 (0.98–1.35; P = 0.083), 1.59 (1.28–1.98; P <0.001), 2.23 (1.47–3.40; P <0.001), and 1.67 (1.34–2.08; P <0.001), respectively. Sensitivity analyses using Iranian WC cutoffs, as well as models adjusted for individual covariates in place of the CVD risk score, together with analyses using multiple imputation and inverse probability weighting, yielded generally consistent results. Even in the absence of CKM risk factors, higher abdominal obesity measures were associated with a higher long-term risk of ASCVD.