Anthropometric Indices and the Risk of Incident Sudden Cardiac Death Among Adults with and Without Diabetes: over 15 years of Follow-up in The Tehran Lipid and Glucose Study

Overview

Journal Diabetol Metab Syndr

Publisher Biomed Central

Specialty Endocrinology

Date 2021 Jul 29

PMID 34321080

Citations 2

Authors

Seyyed Saeed Moazzeni

Seyed Saeed Tamehri Zadeh

Samaneh Asgari

Fereidoun Azizi

Farzad Hadaegh

Affiliations

Soon will be listed here.

Abstract

Background: We investigated the association of anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and hip circumference (HC) with the risk of incident sudden cardiac death (SCD) among Iranian population with and without type 2 diabetes mellitus (T2DM).

Methods: The study population included 9,089 subjects without and 1,185 subjects with T2DM, aged ≥ 20 years. Participants were recruited in 1999-2001 or 2001-2005, and followed for incident SCD annually, up to 20 March 2018. Multivariate Cox proportional hazard models, adjusted for traditional risk factors of cardiovascular disease, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of anthropometric indices (as continuous and categorical variables).

Results: During a follow-up of over 15 years, 144 (1.58%) and 86 (7.26%) incident SCD occurred in non-T2DM and T2DM groups, respectively. Among non-T2DM group, a 1 standard deviation (SD) increase in WHtR was associated with higher risk of incident SCD by a HR of 1.23 (95% CI: 1.00-1.50) in the multivariable model. From the first quartile to the fourth quartile of WHtR, the trend of SCD risk was significant in age- and sex-adjusted analysis (P-value for trend: 0.041). Other indices did not show significant associations with SCD. Among T2DM group, a 1 SD increase in WHR had a HR of 1.36 (1.05-1.76) in the multivariable model. Considering WHR as categorical variables, the trend of SCD risk across quartiles of WHR was significant. Furthermore, a 1 SD increase in HC led to reduced risk of incident SCD with a HR of 0.75 (0.58-0.97) in multivariable analysis; this lower risk remained significant even after adjustment for WC. Compared to the first quartile, the fourth quartile of HC also showed a HR of 0.50 (0.25-0.99) (P-value for trend = 0.018). BMI, WC, and WHtR did not have significant associations with incident SCD.

Conclusion: In our long-term population-based study, we demonstrated central but not general obesity (as assessed by WHR in participants with T2DM, and WHtR in participants without T2DM) as a herald of incident SCD. Moreover, HC can have an inverse association with SCD among participants with T2DM.

Citing Articles

Comparative Evaluation of Waist-to-Height Ratio and BMI in Predicting Adverse Cardiovascular Outcome in People With Diabetes: A Systematic Review.

Tewari A, Kumar G, Maheshwari A, Tewari V, Tewari J Cureus. 2023; 15(5):e38801.

PMID: 37303408 PMC: 10250251. DOI: 10.7759/cureus.38801.

The clinical value of metabolic syndrome and its components with respect to sudden cardiac death using different definitions: Two decades of follow-up from the Tehran Lipid and Glucose Study.

Masrouri S, Moazzeni S, Cheraghloo N, Azizi F, Hadaegh F Cardiovasc Diabetol. 2022; 21(1):269.

PMID: 36463175 PMC: 9719125. DOI: 10.1186/s12933-022-01707-1.

References

Ohira T, Maruyama M, Imano H, Kitamura A, Kiyama M, Okada T . Risk factors for sudden cardiac death among Japanese: the Circulatory Risk in Communities Study. J Hypertens. 2012; 30(6):1137-43. DOI: 10.1097/HJH.0b013e328352ac16. View

Wong C, Brown A, Lau D, Chugh S, Albert C, Kalman J . Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives. Heart Lung Circ. 2018; 28(1):6-14. DOI: 10.1016/j.hlc.2018.08.026. View

Kocovski L, Lee J, Parpia S, Fernandes J, Nair V . Association of Waist-Hip Ratio to Sudden Cardiac Death and Severe Coronary Atherosclerosis in Medicolegal Autopsies. Am J Forensic Med Pathol. 2017; 38(3):226-228. DOI: 10.1097/PAF.0000000000000330. View

Lecomte D, Fornes P, Fouret P, Nicolas G . Isolated myocardial fibrosis as a cause of sudden cardiac death and its possible relation to myocarditis. J Forensic Sci. 1993; 38(3):617-21. View

Ainsworth B, Jacobs Jr D, Leon A . Validity and reliability of self-reported physical activity status: the Lipid Research Clinics questionnaire. Med Sci Sports Exerc. 1993; 25(1):92-8. DOI: 10.1249/00005768-199301000-00013. View

Myerburg R . Scientific gaps in the prediction and prevention of sudden cardiac death. J Cardiovasc Electrophysiol. 2002; 13(7):709-23. DOI: 10.1046/j.1540-8167.2002.00709.x. View

Aune D, Schlesinger S, Norat T, Riboli E . Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018; 33(8):711-722. PMC: 6061127. DOI: 10.1007/s10654-017-0353-9. View

Aune D, Schlesinger S, Norat T, Riboli E . Diabetes mellitus and the risk of sudden cardiac death: A systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis. 2018; 28(6):543-556. DOI: 10.1016/j.numecd.2018.02.011. View

Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, A Zuniga F . Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018; 17(1):122. PMC: 6119242. DOI: 10.1186/s12933-018-0762-4. View

10.

Kim S, Abbasi F . Myths about Insulin Resistance: Tribute to Gerald Reaven. Endocrinol Metab (Seoul). 2019; 34(1):47-52. PMC: 6435844. DOI: 10.3803/EnM.2019.34.1.47. View

11.

Bertoia M, Allison M, Manson J, Freiberg M, Kuller L, Solomon A . Risk factors for sudden cardiac death in post-menopausal women. J Am Coll Cardiol. 2012; 60(25):2674-82. DOI: 10.1016/j.jacc.2012.09.031. View

12.

Manfredini R, Portaluppi F, Grandi E, FERSINI C, Gallerani M . Out-of-hospital sudden death referring to an emergency department. J Clin Epidemiol. 1996; 49(8):865-8. DOI: 10.1016/0895-4356(96)00114-x. View

13.

Panagiotakos D, Pitsavos C, Yannakoulia M, Chrysohoou C, Stefanadis C . The implication of obesity and central fat on markers of chronic inflammation: The ATTICA study. Atherosclerosis. 2005; 183(2):308-15. DOI: 10.1016/j.atherosclerosis.2005.03.010. View

14.

Roth G, Mensah G, Johnson C, Addolorato G, Ammirati E, Baddour L . Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020; 76(25):2982-3021. PMC: 7755038. DOI: 10.1016/j.jacc.2020.11.010. View

15.

Mehra R . Global public health problem of sudden cardiac death. J Electrocardiol. 2007; 40(6 Suppl):S118-22. DOI: 10.1016/j.jelectrocard.2007.06.023. View

16.

Cameron A, Magliano D, Soderberg S . A systematic review of the impact of including both waist and hip circumference in risk models for cardiovascular diseases, diabetes and mortality. Obes Rev. 2012; 14(1):86-94. DOI: 10.1111/j.1467-789X.2012.01051.x. View

17.

Wang H, Huang W, Yang C, Song L, Zhao H, Ren J . [Morphologic features of sudden cardiac death in Yunnan province, with emphasis on myocarditis]. Zhonghua Bing Li Xue Za Zhi. 2008; 36(12):805-9. View

18.

Sudha M, Sundaram S, Purushothaman K, Kumar P, Prathiba D . Coronary atherosclerosis in sudden cardiac death: an autopsy study. Indian J Pathol Microbiol. 2009; 52(4):486-9. DOI: 10.4103/0377-4929.56130. View

19.

Adabag A, Luepker R, Roger V, Gersh B . Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010; 7(4):216-25. PMC: 5014372. DOI: 10.1038/nrcardio.2010.3. View

20.

Sarrafzadegan N, Mohammmadifard N . Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med. 2019; 22(4):204-210. View