1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea.
3Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
4Department of Family Medicine, Korea University College of Medicine, Seoul, Korea.
5Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
Copyright © 2019 Korean Diabetes Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
Values are presented as number (%) or mean±standard deviation. P<0.0001 for all data.
WC, waist circumference; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; COPD, chronic obstructive pulmonary disease.
aWC levels, in cm: level 1 (male <80, female <75), level 2 (male 80 to 84.9, female 75 to 79.9), level 3 (male 85 to 89.9, female 80 to 84.9), level 4 (male 90 to 94.9, female 85 to 89.9), level 5 (male 95 to 99.9, female 90 to 94.9), and level 6 (male ≥100, female ≥95).
P<0.0001 for all data. Model 1 was adjusted for age and sex. Model 2 was adjusted for the variables in model 1 plus smoking, alcohol drinking, regular physical activity, and low-income status. Model 3 was adjusted for the variables in model 2 plus hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease, and cancer. Model 4 was adjusted for the variables in model 3 plus body mass index.
IR, incidence rate; HR, hazard ratio; CI, confidence interval; WC, waist circumference.
aWC levels, in cm: level 1 (male <80, female <75), level 2 (male 80 to 84.9, female 75 to 79.9), level 3 (male 85 to 89.9, female 80 to 84.9), level 4 (male 90 to 94.9, female 85 to 89.9), level 5 (male 95 to 99.9, female 90 to 94.9), and level 6 (male ≥100, female ≥95).
P<0.0001 for all data. Data were adjusted for age, sex, smoking, alcohol drinking, regular physical activity, low-income status, hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease, and cancer.
IR, incidence rate; HR, hazard ratio; CI, confidence interval; WC, waist circumference; BMI, body mass index.
aWC levels, in cm: level 1 (male <65, female <60), level 2 (male 65 to 69.9, female 60 to 64.9), level 3 (male 70 to 74.9, female 65 to 69.9), level 4 (male 75 to 79.9, female 70 to 74.9), level 5 (male 80 to 84.9, female 75 to 79.9), level 6 (male 85 to 89.9, female 80 to 84.9), level 7 (male 90 to 94.9, female 85 to 89.9), level 8 (male 95 to 99.9, female 90 to 94.9), level 9 (male 100 to 104.9, female 95 to 99.9), level 10 (male 105 to 109.9, female 100 to 104.9), and level 11 (male ≥110, female ≥105).
P<0.0001 for all data. Model 1 was adjusted for age and sex. Model 2 was adjusted for the variables in model 1 plus smoking, alcohol drinking, regular physical activity, and low-income status. Model 3 was adjusted for the variables in model 2 plus hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease, and cancer. Model 4 was adjusted for the variables in model 3 plus waist circumference.
IR, incidence rate; HR, hazard ratio; CI, confidence interval; BMI, body mass index.
aBMI levels, in kg/m2: level 1 (<18.5), level 2 (18.5 to 22.9), level 3 (23.0 to 24.9), level 4 (25.0 to 29.9), and level 5 (≥30.0).
Characteristic | WC levelsa | |||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | |
Number | 8,386,445 | 5,032,969 | 4,162,947 | 2,437,161 | 1,101,851 | 627,888 |
Male sex | 3,312,345 (39.5) | 2,903,610 (57.7) | 2,457,563 (59.0) | 1,465,226 (60.1) | 612,705 (55.6) | 317,643 (50.6) |
WC, cm | ||||||
Total | 70.9±5.0 | 79.8±2.9 | 84.8±2.9 | 89.7±2.8 | 94.4±2.9 | 101.5±4.8 |
Male | 74.6±3.8 | 82.0±1.4 | 86.8±1.4 | 91.7±1.4 | 96.6±1.4 | 103.7±4.1 |
Female | 68.5±4.1 | 76.9±1.4 | 81.8±1.4 | 86.7±1.4 | 91.6±1.4 | 99.2±4.5 |
Age, yr | 42.1±13.4 | 47.4±13.1 | 49.8±13.2 | 51.1±13.5 | 51.8±14.0 | 50.6±15.0 |
<40 | 3,595,417 (42.9) | 1,376,730 (27.4) | 909,701 (21.9) | 488,872 (20.1) | 223,869 (20.3) | 159,629 (25.4) |
40–64 | 4,235,117 (50.5) | 3,117,804 (62.0) | 2,652,571 (63.7) | 1,520,454 (62.4) | 653,583 (59.3) | 340,373 (54.2) |
≥65 | 555,911 (6.6) | 538,435 (10.7) | 600,675 (14.4) | 427,835 (17.6) | 224,399 (20.4) | 127,886 (20.4) |
BMI, kg/m2 | 21.05±2.06 | 23.52±1.89 | 25.01±2.01 | 26.52±2.16 | 28.11±2.37 | 30.78±3.20 |
≥25 | 227,951 (2.7) | 1,033,886 (20.5) | 2,056,586 (49.4) | 1,875,224 (76.9) | 1,008,709 (91.6) | 606,915 (96.7) |
Height, cm | 162.4±8.3 | 164.3±9.1 | 164.5±9.5 | 164.9±9.8 | 164.6±10.3 | 164.7±10.7 |
Weight, kg | 55.6±7.8 | 63.6±8.5 | 67.9±9.4 | 72.4±10.4 | 76.5±11.5 | 83.8±13.9 |
SBP, mm Hg | 116.6±13.9 | 122.3±14.4 | 125.1±14.6 | 127.4±14.8 | 129.3±15.0 | 131.7±15.5 |
DBP, mm Hg | 72.9±9.5 | 76.2±9.7 | 77.9±9.9 | 79.2±10.0 | 80.3±10.1 | 81.7±10.5 |
Total cholesterol, mg/dL | 186.3±34.1 | 196.6±36.1 | 201.1±37.0 | 203.5±37.8 | 205.2±38.5 | 206.2±39.2 |
TG, mg/dL | 99.5±74.8 | 135.5±103.3 | 155.2±118.2 | 170.2±129.0 | 178.3±133.2 | 183.7±136.4 |
HDL-C, mg/dL | 60.0±18.5 | 55.1±19.8 | 53.1±20.3 | 51.9±20.5 | 51.4±20.5 | 51.1±20.4 |
LDL-C, mg/dL | 108.0±45.1 | 116.2±43.7 | 119.0±43.4 | 119.9±44.1 | 120.6±44.6 | 120.8±44.0 |
Fasting glucose, mg/dL | 92.1±17.7 | 97.0±22.2 | 99.9±24.6 | 102.5±26.7 | 104.7±28.6 | 107.7±31.9 |
Current smoker | 1,866,304 (22.3) | 1,384,875 (27.6) | 1,120,939 (27.0) | 659,591 (27.2) | 286,356 (26.1) | 164,100 (26.2) |
Heavy drinker | 448,312 (5.4) | 420,821 (8.4) | 389,861 (9.5) | 255,502 (10.6) | 116,501 (10.7) | 65,804 (10.6) |
Regular physical activity | 1,337,872 (16.1) | 949,536 (19.0) | 781,471 (18.9) | 441,790 (18.3) | 188,445 (17.2) | 97,524 (15.6) |
Low income <20% | 1,873,651 (22.3) | 1,025,578 (20.4) | 836,277 (20.1) | 495,310 (20.3) | 233,499 (21.2) | 142,586 (22.7) |
Hypertension | 939,237 (11.2) | 1,120,635 (22.3) | 1,284,989 (30.9) | 950,794 (39.0) | 509,206 (46.2) | 338,565 (53.9) |
Diabetes | 290,687 (3.5) | 377,151 (7.5) | 448,438 (10.8) | 345,115 (14.2) | 192,887 (17.5) | 137,343 (21.9) |
Dyslipidemia | 779,342 (9.3) | 870,873 (17.3) | 945,568 (22.7) | 655,070 (26.9) | 335,175 (30.4) | 209,085 (33.3) |
COPD | 366,482 (4.4) | 257,681 (5.1) | 243,345 (5.9) | 158,786 (6.5) | 78,837 (7.2) | 47,397 (7.6) |
Cancer | 131,594 (1.6) | 88,036 (1.8) | 78,144 (1.9) | 48,068 (2.0) | 22,093 (2.0) | 12,257 (2.0) |
WC levelsa | Total no. | No. of events | IR (per 1,000 person years) | Multivariate-adjusted HR (95% CI) | |||
---|---|---|---|---|---|---|---|
Model 1 | Model 2 | Model 3 | Model 4 | ||||
Total | |||||||
Myocardial infarction | |||||||
1 | 8,386,445 | 28,938 | 0.639 | 0.767 (0.755–0.780) | 0.747 (0.735–0.759) | 0.851 (0.837–0.865) | 0.841 (0.825–0.858) |
2 | 5,032,969 | 28,648 | 1.038 | 0.891 (0.877–0.906) | 0.884 (0.870–0.899) | 0.934 (0.919–0.950) | 0.942 (0.926–0.958) |
3 | 4,162,947 | 30,698 | 1.344 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
4 | 2,437,161 | 21,413 | 1.607 | 1.090 (1.071–1.109) | 1.094 (1.075–1.114) | 1.040 (1.021–1.058) | 1.025 (1.007–1.044) |
5 | 1,101,851 | 11,028 | 1.842 | 1.208 (1.182–1.234) | 1.212 (1.186–1.239) | 1.098 (1.074–1.122) | 1.062 (1.038–1.088) |
6 | 627,888 | 6,564 | 1.955 | 1.357 (1.321–1.393) | 1.348 (1.312–1.385) | 1.148 (1.117–1.179) | 1.067 (1.034–1.102) |
Ischemic stroke | |||||||
1 | 8,386,445 | 41,156 | 0.909 | 0.811 (0.800–0.822) | 0.795 (0.784–0.806) | 0.911 (0.898–0.923) | 0.883 (0.868–0.897) |
2 | 5,032,969 | 40,647 | 1.475 | 0.923 (0.910–0.935) | 0.918 (0.905–0.930) | 0.972 (0.958–0.985) | 0.957 (0.943–0.971) |
3 | 4,162,947 | 43,360 | 1.902 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
4 | 2,437,161 | 30,652 | 2.305 | 1.081 (1.065–1.096) | 1.083 (1.067–1.099) | 1.026 (1.011–1.042) | 1.037 (1.021–1.053) |
5 | 1,101,851 | 16,113 | 2.698 | 1.189 (1.168–1.211) | 1.188 (1.166–1.210) | 1.071 (1.051–1.091) | 1.086 (1.066–1.108) |
6 | 627,888 | 9,709 | 2.899 | 1.330 (1.301–1.360) | 1.318 (1.289–1.347) | 1.113 (1.088–1.138) | 1.128 (1.099–1.157) |
Male | |||||||
Myocardial infarction | |||||||
1 | 3,312,345 | 17,042 | 0.938 | 0.806 (0.790–0.823) | 0.766 (0.750–0.782) | 0.880 (0.861–0.898) | 0.870 (0.848–0.893) |
2 | 2,903,610 | 18,789 | 1.171 | 0.909 (0.891–0.927) | 0.895 (0.877–0.914) | 0.948 (0.929–0.968) | 0.959 (0.939–0.980) |
3 | 2,457,563 | 19,058 | 1.407 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
4 | 1,465,226 | 12,998 | 1.619 | 1.079 (1.056–1.104) | 1.088 (1.063–1.112) | 1.029 (1.006–1.053) | 1.011 (0.988–1.035) |
5 | 612,705 | 5,960 | 1.790 | 1.190 (1.156–1.225) | 1.205 (1.170–1.241) | 1.083 (1.052–1.116) | 1.041 (1.009–1.074) |
6 | 317,643 | 3,031 | 1.785 | 1.302 (1.253–1.353) | 1.312 (1.263–1.364) | 1.103 (1.061–1.147) | 1.011 (0.966–1.057) |
Ischemic stroke | |||||||
1 | 3,312,345 | 23,618 | 1.301 | 0.860 (0.845–0.876) | 0.825 (0.810–0.840) | 0.953 (0.936–0.971) | 0.909 (0.890–0.929) |
2 | 2,903,610 | 25,017 | 1.561 | 0.945 (0.929–0.962) | 0.934 (0.918–0.951) | 0.991 (0.973–1.008) | 0.968 (0.951–0.987) |
3 | 2,457,563 | 24,792 | 1.833 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
4 | 1,465,226 | 17,096 | 2.132 | 1.069 (1.049–1.091) | 1.077 (1.056–1.098) | 1.017 (0.997–1.037) | 1.033 (1.012–1.055) |
5 | 612,705 | 7,975 | 2.400 | 1.190 (1.160–1.220) | 1.197 (1.167–1.228) | 1.073 (1.045–1.100) | 1.096 (1.066–1.126) |
6 | 317,643 | 3,980 | 2.347 | 1.287 (1.245–1.331) | 1.285 (1.242–1.329) | 1.072 (1.036–1.109) | 1.087 (1.045–1.131) |
Female | |||||||
Myocardial infarction | |||||||
1 | 5,074,100 | 11,896 | 0.438 | 0.763 (0.744–0.784) | 0.757 (0.737–0.777) | 0.845 (0.823–0.868) | 0.833 (0.807–0.859) |
2 | 2,129,359 | 9,859 | 0.854 | 0.875 (0.852–0.899) | 0.876 (0.853–0.900) | 0.921 (0.897–0.947) | 0.923 (0.898–0.950) |
3 | 1,705,384 | 11,640 | 1.253 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
4 | 971,935 | 8,415 | 1.589 | 1.100 (1.069–1.131) | 1.099 (1.068–1.130) | 1.049 (1.020–1.079) | 1.042 (1.012–1.072) |
5 | 489,146 | 5,068 | 1.908 | 1.203 (1.164–1.244) | 1.202 (1.163–1.243) | 1.101 (1.065–1.138) | 1.079 (1.041–1.118) |
6 | 310,245 | 3,533 | 2.129 | 1.365 (1.315–1.418) | 1.352 (1.302–1.404) | 1.169 (1.125–1.214) | 1.110 (1.061–1.160) |
Ischemic stroke | |||||||
1 | 5,074,100 | 17,538 | 0.647 | 0.760 (0.745–0.776) | 0.753 (0.738–0.769) | 0.850 (0.832–0.869) | 0.840 (0.820–0.861) |
2 | 2,129,359 | 15,630 | 1.356 | 0.894 (0.875–0.913) | 0.894 (0.875–0.913) | 0.944 (0.924–0.964) | 0.938 (0.917–0.959) |
3 | 1,705,384 | 18,568 | 2.002 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
4 | 971,935 | 13,556 | 2.567 | 1.093 (1.069–1.118) | 1.091 (1.067–1.116) | 1.038 (1.015–1.062) | 1.042 (1.018–1.066) |
5 | 489,146 | 8,138 | 3.073 | 1.179 (1.149–1.210) | 1.175 (1.144–1.206) | 1.067 (1.039–1.096) | 1.074 (1.044–1.104) |
6 | 310,245 | 5,729 | 3.465 | 1.346 (1.307–1.387) | 1.336 (1.296–1.376) | 1.141 (1.107–1.175) | 1.151 (1.112–1.192) |
WC levelsa | Total no. | No. of events | IR (per 1,000 person years) | Multivariate-adjusted HR (95% CI) | |
---|---|---|---|---|---|
Total | Total (adding BMI as a variable) | ||||
Myocardial infarction | |||||
1 | 195,032 | 658 | 0.639 | 0.906 (0.838–0.980) | 0.887 (0.815–0.965) |
2 | 1,068,597 | 2,591 | 0.455 | 0.826 (0.793–0.860) | 0.833 (0.797–0.870) |
3 | 2,810,721 | 8,200 | 0.542 | 0.813 (0.793–0.833) | 0.818 (0.796–0.841) |
4 | 4,312,095 | 17,489 | 0.746 | 0.871 (0.855–0.887) | 0.875 (0.857–0.893) |
5 | 5,032,969 | 28,648 | 1.038 | 0.934 (0.919–0.949) | 0.936 (0.921–0.952) |
6 | 4,162,947 | 30,698 | 1.344 | 1 (Ref) | 1 (Ref) |
7 | 2,437,161 | 21,413 | 1.607 | 1.040 (1.022–1.058) | 1.038 (1.019–1.057) |
8 | 1,101,851 | 11,028 | 1.842 | 1.098 (1.074–1.123) | 1.094 (1.068–1.120) |
9 | 418,626 | 4,356 | 1.934 | 1.115 (1.080–1.152) | 1.107 (1.070–1.146) |
10 | 140,496 | 1,549 | 2.076 | 1.221 (1.160–1.286) | 1.212 (1.147–1.280) |
11 | 68,766 | 659 | 1.836 | 1.215 (1.124–1.313) | 1.184 (1.090–1.286) |
Ischemic stroke | |||||
1 | 195,032 | 926 | 0.899 | 0.882 (0.826–0.942) | 0.852 (0.794–0.914) |
2 | 1,068,597 | 3,516 | 0.618 | 0.849 (0.820–0.879) | 0.808 (0.778–0.838) |
3 | 2,810,721 | 11,767 | 0.778 | 0.894 (0.875–0.912) | 0.859 (0.839–0.879) |
4 | 4,312,095 | 24,947 | 1.065 | 0.929 (0.914–0.944) | 0.904 (0.889–0.920) |
5 | 5,032,969 | 40,647 | 1.475 | 0.972 (0.958–0.985) | 0.959 (0.945–0.972) |
6 | 4,162,947 | 43,360 | 1.902 | 1 (Ref) | 1 (Ref) |
7 | 2,437,161 | 30,652 | 2.305 | 1.026 (1.011–1.042) | 1.040 (1.025–1.056) |
8 | 1,101,851 | 16,113 | 2.698 | 1.071 (1.052–1.091) | 1.101 (1.079–1.122) |
9 | 418,626 | 6,468 | 2.879 | 1.086 (1.058–1.115) | 1.132 (1.100–1.165) |
10 | 140,496 | 2,310 | 3.104 | 1.186 (1.137–1.238) | 1.258 (1.203–1.316) |
11 | 68,766 | 931 | 2.599 | 1.139 (1.067–1.216) | 1.234 (1.152–1.322) |
BMI levelsa | Total no. | No. of events | IR (per 1,000 person years) | Multivariate-adjusted HR (95% CI) | |||
---|---|---|---|---|---|---|---|
Model 1 | Model 2 | Model 3 | Model 4 | ||||
Myocardial infarction | |||||||
1 | 928,037 | 4,662 | 0.940 | 1.127 (1.093–1.162) | 1.072 (1.039–1.105) | 1.153 (1.119–1.189) | 1.215 (1.177–1.253) |
2 | 8,789,234 | 41,030 | 0.860 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
3 | 5,222,719 | 32,305 | 1.128 | 1.110 (1.094–1.126) | 1.148 (1.131–1.165) | 1.063 (1.047–1.079) | 0.992 (0.976–1.008) |
4 | 6,021,912 | 43,536 | 1.323 | 1.295 (1.278–1.313) | 1.353 (1.335–1.372) | 1.166 (1.150–1.182) | 1.037 (1.019–1.057) |
5 | 787,359 | 5,756 | 1.373 | 1.711 (1.664–1.759) | 1.763 (1.714–1.813) | 1.355 (1.317–1.394) | 1.159 (1.118–1.201) |
Ischemic stroke | |||||||
1 | 928,037 | 6,491 | 1.310 | 0.916 (0.893–0.940) | 0.874 (0.852–0.897) | 0.953 (0.929–0.978) | 0.992 (0.967–1.019) |
2 | 8,789,234 | 62,588 | 1.314 | 1 (Ref) | 1 (Ref) | 1 (Ref) | 1 (Ref) |
3 | 5,222,719 | 46,450 | 1.624 | 1.065 (1.053–1.078) | 1.096 (1.083–1.110) | 1.011 (0.999–1.024) | 0.958 (0.945–0.971) |
4 | 6,021,912 | 58,949 | 1.794 | 1.180 (1.167–1.193) | 1.221 (1.207–1.235) | 1.044 (1.032–1.056) | 0.943 (0.928–0.957) |
5 | 787,359 | 7,159 | 1.709 | 1.457 (1.422–1.493) | 1.483 (1.447–1.520) | 1.123 (1.095–1.151) | 0.955 (0.926–0.985) |
Outcome | Sex | WC cutoff, cm | Sensitivity | Specificity | Youden's index | Area under the curve |
---|---|---|---|---|---|---|
Myocardial infarction | Male | 84 | 0.588 | 0.509 | 1.097 | 0.563 |
Female | 78 | 0.649 | 0.603 | 1.251 | 0.667 | |
Ischemic stroke | Male | 85 | 0.525 | 0.562 | 1.088 | 0.558 |
Female | 78 | 0.663 | 0.603 | 1.267 | 0.677 |
Values are presented as number (%) or mean±standard deviation. WC, waist circumference; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; COPD, chronic obstructive pulmonary disease. aWC levels, in cm: level 1 (male <80, female <75), level 2 (male 80 to 84.9, female 75 to 79.9), level 3 (male 85 to 89.9, female 80 to 84.9), level 4 (male 90 to 94.9, female 85 to 89.9), level 5 (male 95 to 99.9, female 90 to 94.9), and level 6 (male ≥100, female ≥95).
IR, incidence rate; HR, hazard ratio; CI, confidence interval; WC, waist circumference. aWC levels, in cm: level 1 (male <80, female <75), level 2 (male 80 to 84.9, female 75 to 79.9), level 3 (male 85 to 89.9, female 80 to 84.9), level 4 (male 90 to 94.9, female 85 to 89.9), level 5 (male 95 to 99.9, female 90 to 94.9), and level 6 (male ≥100, female ≥95).
IR, incidence rate; HR, hazard ratio; CI, confidence interval; WC, waist circumference; BMI, body mass index. aWC levels, in cm: level 1 (male <65, female <60), level 2 (male 65 to 69.9, female 60 to 64.9), level 3 (male 70 to 74.9, female 65 to 69.9), level 4 (male 75 to 79.9, female 70 to 74.9), level 5 (male 80 to 84.9, female 75 to 79.9), level 6 (male 85 to 89.9, female 80 to 84.9), level 7 (male 90 to 94.9, female 85 to 89.9), level 8 (male 95 to 99.9, female 90 to 94.9), level 9 (male 100 to 104.9, female 95 to 99.9), level 10 (male 105 to 109.9, female 100 to 104.9), and level 11 (male ≥110, female ≥105).
IR, incidence rate; HR, hazard ratio; CI, confidence interval; BMI, body mass index. aBMI levels, in kg/m2: level 1 (<18.5), level 2 (18.5 to 22.9), level 3 (23.0 to 24.9), level 4 (25.0 to 29.9), and level 5 (≥30.0).
WC, waist circumference.