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Chronic Kidney Disease and Diabetes / Diabetes, Cardiovascular Risks, and Lipoproteins · Journal article
Diabetology & Metabolic Syndrome · September 10, 2026
Well-designed and adequately powered for the question it asks.
Among 691 initially CKM stage 0 adults followed for a median 19.6 years, abdominal obesity measures—particularly waist circumference, waist-to-height ratio, and waist-to-hip ratio—showed strong linear associations with incident ASCVD risk independent of traditional CVD risk factors, whereas BMI showed a weaker association. This indicates that abdominal obesity phenotyping may identify long-term cardiovascular risk even in metabolically healthy individuals.
Prospective cohort study. Adults enrolled in the Tehran Lipid and Glucose Study who were free of cardiovascular-kidney-metabolic syndrome risk factors at baseline; 47.6% women, mean age 40.4 (SD 10.4) years.. Intervention: Baseline measurement of obesity dimensions: body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio.. Compared with: Risk of incident ASCVD by obesity measure category across follow-up.. n = 691. Tehran, Iran (Tehran Lipid and Glucose Study)..
58 of 691 participants (8.4%) developed ASCVD during median 19.6-year follow-up. Waist circumference: HR 1.59 per 5 cm increase (95% CI 1.28–1.98; P <0.001) after PREVENT risk score adjustment. Waist-to-height ratio: HR 2.23 per 0.05 increase (95% CI 1.47–3.40; P <0.001) after adjustment.
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Clinicians should consider measuring abdominal obesity dimensions (waist circumference, waist-to-height ratio, waist-to-hip ratio) as complementary risk markers for long-term ASCVD in metabolically healthy individuals, as these measures show stronger associations with 20-year cardiovascular risk than BMI alone. This supports targeted prevention strategies based on fat distribution phenotyping even when traditional metabolic risk factors are absent.
Prospective cohort study with 19.6-year median follow-up, hard clinical endpoint (incident ASCVD), and consistent dose–response relationships across multiple abdominal obesity measures with statistical significance and robust sensitivity analyses.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should consider measuring abdominal obesity dimensions (waist circumference, waist-to-height ratio, waist-to-hip ratio) as complementary risk markers for long-term ASCVD in metabolically healthy individuals, as these measures show stronger associations with 20-year cardiovascular risk than BMI alone. This supports targeted prevention strategies based on fat distribution phenotyping even when traditional metabolic risk factors are absent.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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.
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