Waist-to-Height Ratio and the Risk of Cardiovascular Outcomes and Mortality in Type 2 Diabetes With and Without Abdominal Obesity

Abstract

Aim Waist-to-height ratio (WHtR) has been suggested as a superior marker of cardiometabolic risk compared to waist circumference (WC), but evidence in type 2 diabetes mellitus (T2DM) remains limited.Materials and Methods A population-based cohort of 2 076 104 patients with T2DM who underwent the Korean national health checkup between 2015 and 2016 were followed until 2022. Multivariable Cox proportional hazards regression was performed to analyse the association between WHtR and the risk of incident myocardial infarction, stroke and mortality. Restricted cubic spline analyses were performed to evaluate continuous dose-response relationships, with additional stratification by abdominal obesity.Results During follow-up, 125 493 deaths (6.0%), 56 280 myocardial infarctions (2.7%) and 62 938 strokes (3.0%) occurred. WHtR showed increasing association with the risk of myocardial infarction and stroke, and a U-shaped association with all-cause mortality. Individuals with both abdominal obesity and WHtR >= 0.5 had higher risks of myocardial infarction (HR 1.12, 95% CI 1.07-1.17), stroke (HR 1.18, 95% CI 1.15-1.21) and mortality (HR 1.20, 95% CI 1.16-1.25). In those without abdominal obesity, WHtR >= 0.5 was also associated with increased cardiovascular risks but slightly lower mortality. In contrast, those with abdominal obesity but normal WHtR had no significantly increased risks for any outcomes. The associations were stronger in younger adults and individuals with new-onset T2DM for cardiovascular outcomes, and in those with long-standing T2DM for mortality.Conclusions WHtR was independently associated with cardiovascular outcomes and mortality in individuals with T2DM, including those without abdominal obesity. This simple measurement may provide additional information beyond WC for evaluating cardiometabolic risk in this population.