The association between waist circumference, weight-adjusted waist index, waist-to-height ratio and waist divided by height and the prevalence of cardiovascular diseases in patients with diabetes.

Background: The waist circumference (WC), waist-to-height ratio (WHtR), waist divided by height(WHT.5R), and weight-adjusted waist index (WWI) are four anthropometric indices evaluating obesity, but the association with cardiovascular diseases in diabetic population remain unclear.

Methods: We extracted data from the National Health and Nutrition Examination Survey (NHANES1999-2016),and 7000 patients with diabetes were eligible. Weighted logistic regression and weighted restricted cubic spline analyses were performed to explore the association between WC, WWI, WHtR, WTH.5R and the likelihood of cardiovascular disease (CVD), congestive heart failure (CHF), coronary artery disease (CAD), and stroke. Stratified analyses and interaction tests were further conducted.

Results: The WHtR index demonstrated a statistically significant positive linear relationship with the likelihoodof CVD [Quartile 4, full adjusted: OR 1.84(1.38,2.47)], CHF [Quartile 4, full adjusted: OR 2.35(1.51,3.66)], CAD [Quartile 4, full adjusted: OR 1.43(1.06,1.94)] and stroke [Quartile 4, full adjusted: OR 1.59(1.01,2.51)]. Moreover, the WC and WHT.5R were positively associated withCVD [Quartile 4, full adjusted: WC OR 1.95(2.44,2.65); WHT.5R OR 2.01(1.53,2.63)], CHF [Quartile 4, full adjusted: WC OR 2.83(1.79,4.47); WHT.5R OR 2.33(1.52,3.58)], and CAD [Quartile 4, full adjusted: WC OR 1.64(1.22,2.21); WHT.5R OR 1.43(1.06,1.94)], while WWI exhibited a similar association with the prevalence ratesof CVD [Quartile 4, full adjusted: OR 1.76(1.29,2.42)] and CAD [Quartile 4, full adjusted: OR 1.51(1.04,2.19)]. RCS analyses showed that all indices had a linear relationship with the probability of CVD, CHF, CAD, and stroke.

Conclusions: This study highlighted the application prospect of these four indicators in predicting cardiovascular disease ability in patients with diabetes, especially the WHtR index.