Abdominal fat may indicate a person’s risk of cardiovascular disease (CVD), even if other health factors are not taken into account, according to a recent study.
Research published today in the Journal of the American Heart Association reveals that having a high body roundness index (BRI) over a six-year span can lead to a greater risk of cardiovascular disease in adults aged 45 and older. This study highlights the potential of BRI, which measures abdominal fat and body shape, to assess CVD risk.
Cardiovascular disease remains the leading global cause of death, resulting in almost 20 million fatalities each year, as reported by the American Heart Association’s 2024 Heart Disease and Stroke Statistics Update. Obesity is a key changeable risk factor for CVD, and studies suggest that abdominal obesity could pose a more significant risk than overall obesity.
The body roundness index (BRI) measures the relationship between waist circumference and height, providing insight into the proportion of visceral fat. This contrasts with body mass index (BMI), which only evaluates weight in relation to height. Prior research has indicated that BRI is a useful predictor for the likelihood of developing cardiovascular disease and may also help identify insulin resistance and metabolic syndrome.
This study assessed the link between BRI and cardiovascular disease by examining data from the China Health and Retirement Longitudinal Study (CHARLS), which includes a nationally representative sample of older adults in China.
Senior author Yun Qian, M.D., Ph.D., from Nanjing Medical University’s Wuxi Center for Disease Control and Prevention, noted, “This is the first significant study to track BRI over time and its correlation with the incidence of cardiovascular disease in middle-aged and older Chinese adults.”
Researchers analyzed BRI data collected from 2011 to 2016, studying how participants’ BRI levels changed over time. Instead of focusing on a single BRI reading, they explored various trajectories of BRI changes, allowing for a thorough understanding of fluctuations. Participants with similar BRI trends were categorized into groups, which were then compared: low-stable BRI group, moderate-stable BRI group, and high-stable BRI group.
The findings revealed that higher BRI trajectories significantly correlated with an increased risk of developing cardiovascular disease. Participants with consistently higher BRI measurements showed a greater risk for cardiovascular disease, strokes, and other heart-related events, regardless of their age, gender, or other factors. Over the last four years of monitoring (2017 to 2020), there were 3,052 recorded cardiovascular incidents and 894 cardiovascular deaths.
The researchers discovered:
- The moderate-stable BRI group had a 61% higher risk of cardiovascular disease compared to the low-stable BRI group, while the high-stable BRI group faced a 163% increased risk.
- Even after adjusting for demographics, medical history, and cardiac medications, the moderate-stable and high-stable BRI groups still exhibited significantly higher CVD risks compared to those in the low-stable BRI group.
- Taking into account additional health metrics like blood pressure, blood sugar, and cholesterol levels did not diminish the heightened CVD risk for participants in the moderate-stable and high-stable BRI groups during the study period.
- The occurrence of strokes and other cardiac events was notably elevated among those in the moderate-stable and high-stable BRI groups.
“Our research suggests that a six-year trajectory of moderate to high BRI increases the likelihood of cardiovascular disease,” Qian remarked. “This trend can be attributed to the relationship between obesity and other risk factors, such as hypertension, high cholesterol, and Type 2 diabetes, which all contribute to CVD. Furthermore, obesity can lead to inflammation and other processes affecting heart health. More research is essential to validate and clarify how these findings might help in preventing cardiovascular disease.”
Study methodology, background, and specific details:
- The researchers analyzed data from over 9,935 adults in China, aged 45 and older, averaging 58 years old at the study’s start. 53% were men, and 47% were women. None of the participants reported having been diagnosed with cardiovascular disease from 2011 to 2015.
- Participants were sampled from 150 counties across 28 provinces in China, using administrative villages and urban neighborhoods as the primary sampling units.
- A medical team from the Chinese Center for Disease Control and Prevention measured participants’ waist circumference and height during their enrollment. Follow-up measurements occurred biennially.
- Blood samples were taken at enrollment (2011-2012) and again in 2013-2014, with this analysis relying on samples from the initial enrollment period.
- Blood pressure was measured using an electronic monitor after participants rested for five minutes, establishing average readings over three measurements taken at each visit.
- Participants provided their health and demographic information, disclosing the presence of chronic diseases and lifestyle risk factors.
- Throughout the study, participants self-reported any diagnoses of heart-related conditions, such as heart attacks or strokes.
It is important to note the study’s limitations, including its focus on adults in China, which may limit the applicability of the findings to other populations. Additionally, a six-year follow-up duration may be too short to adequately capture changes in BRI. Lastly, CVD diagnoses were based on participant reports rather than medical records, potentially introducing bias or inaccuracies.
The manuscript includes details on co-authors, disclosures, and funding sources.
