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High waist:hip ratio a marker for atherosclerosis

In the Clinical Review section, Dr Peter Savill reviewed a paper that quantified the association between different measures of obesity (BMI, waist circumference and waist to hip ratio) and the prevalence of atherosclerosis.

The researchers concluded that waist to hip ratio is the best marker for atherosclerosis ‘Waist:hip ratio best marker for atherosclerosis' (Practitioner 2008;252 (1699):8).1

However, the pathogenesis of atheroma remains unexplained. All of these markers, whether it be abnormal lipids, waist to hip ratios etc, are just surrogate entities for an abnormal disease state that to this day remains elusive.

We should not confuse these markers as being the ‘cause' of the disease. They are merely associations. Improving waist to hip ratios and lipids does not imply we will cure atherosclerosis. There are a lot of thin, normolipidaemic patients out there who have suffered myocardial infarctions.

Dr Narinder Bassi, GP, Nottingham

Dr Peter Savill replies:

Certainly atherosclerosis is a pathological entity with a multifactorial aetiology. However, lipids and lipoprotein metabolism are a key component of this process. The primary message from this study was that waist to hip ratio appears to be a better marker for obesity in that it is a more accurate predictor of atheroma than BMI or waist circumference; there was no suggestion that waist to hip ratio, or indeed obesity, directly causes atheroma.

Waist to hip ratio is a simple clinical measurement that can identify patients at higher risk of a significant atherosclerotic burden, which in turn could translate into a higher risk of cardiovascular events.

I fully accept that thin, normolipidaemic patients can have cardiovascular events and this review made no suggestions to the contrary. The review simply illustrates the point that the aetiology of atherosclerosis and subsequent clinical events is multifactorial, and highlights the importance of assessing overall cardiovascular risk.

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