General versus central adiposity as risk factors for cardiovascular-related outcomes in a high-risk population with type 2 diabetes: a post hoc analysis of the REWIND trial
Authors' conclusion
In this post hoc analysis of the REWIND placebo group, WHR, WC and/or WC adjusted for HC were risk factors for MACE-3, CVD-related mortality, and all-cause mortality; while BMI was only a risk factor for HF requiring hospitalization. These findings indicate the need for anthropometric measures that consider body fat distribution when assessing CV risk.
Study context
- Population
- Placebo group of REWIND: T2D, age ≥ 50 years, previous cardiovascular (CV) event or CV risk factors, BMI ≥ 23 kg/m²placebo group
- Participants
- 4,952 participants
- Comparison
- BMI vs waist-to-hip ratio (WHR) vs waist circumference (WC) as baseline risk factors for CV outcomes
- Primary endpoint
- MACE-3
- Follow-up
- Median 5.4 years
Methodological detailsplacebo group only, Cox proportional hazard models, adjusted for age, sex and LASSO-selected baseline factors, per 1 SD increase
- Placebo group only
- Cox proportional hazard models
- Adjusted for age, sex and LASSO-selected baseline factors
- Per 1 SD increase
Primary result
As reported in the abstract
Hazard ratio (95% CI)P value
WHRper 1 SD increase
1.11(1.03–1.21)
P = 0.009WCper 1 SD increase
1.12(1.02–1.22)
P = 0.012WC adjusted for HCper 1 SD increase; strongest association
1.26(1.09–1.46)
P = 0.002Per 1 SD increase, as printed
- Events in placebo group
- 663 MACE-3 events
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| HF requiring hospitalization · median follow-up 5.4 yearsWC · per 1 SD increase | 1.34 (1.16–1.54) | P < 0.001 | |
| HF requiring hospitalization · median follow-up 5.4 yearsBMI · per 1 SD increase | 1.33 (1.17–1.50) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
- Heart failure (HF) requiring hospitalization — Events
- 226
Cardiovascular disease (CVD)-related mortality and all-cause mortality · median follow-up 5.4 years
- Events
- 346 CVD-related deaths, 592 all-cause deaths
- Results for CVD-related mortality and all-cause mortality were similar to MACE-3
HF requiring hospitalization · median follow-up 5.4 years
- WHR and WC adjusted for hip circumference (HC) were not risk factors for HF requiring hospitalization
Interaction with sex
- No significant interaction with sex was observed
Original publication
General versus central adiposity as risk factors for cardiovascular-related outcomes in a high-risk population with type 2 diabetes: a post hoc analysis of the REWIND trial. Cardiovasc Diabetol. Published 10 March 2023. doi:10.
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