Abstract
BACKGROUND: It has been reported that obesity and diabetes are both risk factors for the development of cardiovascular diseases (CVDs). However, recent articles reported that compared with body mass index, waist circumference (WC) can better reflect obesity, more closely related to visceral fat tissue which is positively associated with an increased risk of cardiovascular death. Moreover, few studies have investigated the prognostic value of both WC and diabetes during a long-term follow-up. We aimed to investigate whether the higher level of WC measurements and diabetes were able to predict cardiovascular mortality in the general population. METHODS: In this prospective cohort study, a total of 1,521 consecutive subjects free of clinical CVD were included. The endpoint was cardiovascular death. The Kaplan-Meier method and Cox regression models were used to evaluate the cumulative risk of the outcome at different WC levels with or without diabetes. RESULTS: During a median follow-up of 9.2 years, 265 patients died due to cardiovascular conditions. Kaplan-Meier survival estimates indicated that the patients with higher levels of WC (WC > 94 cm) coexisted with diabetes had a significantly increased risk of cardiovascular death (log-rank p < 0.05). After adjustment for potential confounders, multiple COX regression models showed that the incidence of cardiovascular death was significantly higher when patients with high WC coexisted with diabetes mellitus (hazard ratio: 3.78; 95% CI: 3.35-3.98; p < 0.001). CONCLUSION: Patients with high WC and diabetes represent a high-risk population for cardiovascular death. WC and diabetes may provide incremental prognostic value beyond traditional risks factors.