Abstract
Various obesity indices have been linked to cardiovascular disease (CVD) and mortality. This study evaluates the relationship between nine obesity indices and CVD and all-cause mortality. The study utilized data from the Isfahan cohort, involving 4,278 healthy participants aged over 35, followed for 17 years for incidents of myocardial infarction (MI), unstable angina (UA), stroke, and sudden cardiac death (SCD). Nine obesity indices were assessed: body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), abdominal volume index (AVI), conicity index (CI), body adiposity index (BAI), a body shape index (ABSI), and body roundness index (BRI). Cox regression analysis was conducted to determine hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events and all-cause mortality. After adjusting for confounders, WHtR and BRI were significantly associated with CVD (HR: 1.14, 95% CI: 1.03–1.24; HR: 1.04, 95% CI: 1.01–1.06), stroke (HR: 1.22, 95% CI: 1.02–1.45; HR: 1.05, 95% CI: 1.01–1.09), and UA (HR: 1.18, 95% CI: 1.04–1.33; HR: 1.04, 95% CI: 1.01–1.08). BMI was also linked to increased risk of CVD (HR: 1.03, 95% CI: 1.01–1.05) and UA (HR: 1.05, 95% CI: 1.02–1.08). BAI showed a positive association with CVD (HR: 1.02, 95% CI: 1.01–1.03) and stroke (HR: 1.04, 95% CI: 1.01–1.06). Other indices like AVI and WC were only significantly associated with UA. WHR, CI, and ABSI associations diminished after full adjustment, and no obesity indices correlated with CVD mortality or all-cause mortality. Over the study period, different obesity indices exhibited varying associations with cardiovascular events. However, after adjusting for potential confounders, none were significantly associated with CVD mortality or all-cause mortality. Understanding these relationships is crucial for improving adult health and designing effective prevention strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-025-17193-w.