Waist-to-hip ratio is better at predicting subclinical atherosclerosis than body mass index and waist circumference in postmenopausal women

Objective Body fat distribution becomes more central after menopause. Although some studies have identified the superiority of various anthropometric indices to assess general health outcomes, very limited studies have compared the efficacy of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) to predict subclinical atherosclerosis according to menopausal status. Methods In total, 442 participants (209 premenopausal women and 233 postmenopausal women) were prospectively enrolled from the Health Promotion Center of Korea University Guro Hospital. We examined subclinical atherosclerosis using carotid intima-media thickness (CIMT) and brachial-ankle pulse wave velocity (baPWV). Results In premenopausal women, all anthropometric parameters such as BMI, WC and WHR were positively correlated with baPWV and CIMT values, whereas in postmenopausal women, only WHR was positively correlated with baPWV values (0.27, P < 0.01), and WC and WHR were positively correlated with CIMT (0.15, P < 0.05 and 0.21, P < 0.01, respectively). By receiver operating characteristic (ROC) curve analyses, WHR was superior to the other anthropometric indices to predict carotid atherosclerosis in postmenopausal women. Furthermore, the normal weight (BMI < 23 kg/m²) with higher WHR group had a significantly thicker CIMT when compared to the normal weight with lower WHR group (0.76 mm vs. 0.68 mm, P < 0.01) and even the overweight subjects with BMI ≥ 23 kg/m² (0.76 mm vs. 0.70 mm, P < 0.01) in postmenopausal women. Conclusions The present study shows that WHR has the best potential for predicting subclinical atherosclerosis compared to BMI and WC in postmenopausal women. Clinical trials number NCT01594710.