Predictive Value of Waist Height Ratio, Waist Hip Ratio and Body Mass Index in Assessing Angiographic Severity of Coronary Artery Disease in Myocardial Infarction Patients.

Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. The body mass index (BMI), waist hip ratio (WHR) and waist height ratio (WHtR) are some of the clinical tools enabling clinicians to assess obesity. Although for decades there have been controversy regarding the relationship between obesity and CAD; it has been assumed that high BMI is a risk factor for CAD. However, the findings of some recent studies were paradoxical. The aim of this study was to identify the best tool among BMI, WHtR and WHR to evaluate angiographically severe CAD in myocardial infarction patients. This was a cross-sectional analytical study carried out in the Department of Cardiology, Chattogram Medical College and Hospital (CMCH), Chattogram, Bangladesh from January 2017 to December 2017. Three hundred and thirty two consecutive MI patients undergoing CAG during the study period were included in the study as per inclusion and exclusion criteria. Severity of CAD was calculated by using Gensini score. Patients were categorized and compared according to anthropometric indices and CAD severity. The mean±SD of the age of study population was 53.62±10.36 years (range 25-92) and 276(83.1%) were male. Regarding cardiovascular risk factors, 113(34%) patients had diabetes mellitus, 108(32.5%) had dyslipidaemia, 137(41.3%) had hypertension, 205(61.7%) were current or ex-smokers and 59(17.8%) had a family history of CAD. The mean±SD of the patients' BMI was 24.05±3.24kg/m² (range 16.14-32.72), mean±SD of their WHR was 0.964±0.052 (range 0.823-1.125) and mean±SD of their WHtR was 0.546±0.059 (range 0.389-0.748). The mean±SD of the severity of CAD according to the Gensini score was 41.11±28.66 (ranged from 2 to 244). Study findings showed a positive correlation between the severity of CAD with WHtR and WHR but not with BMI, according to Gensini scores (p=0.004, p=0.023 and p=0.43 respectively). Receiver Operating Characteristics (ROC) curve analysis revealed that waist height ratio had the highest area under the curve (AUC) among the three anthropometric parameters for predicting presence of severe CAD. Study showed the superiority of WHtR over WHR and BMI for predicting angiographic severity of CAD in patients with MI. WHtR should therefore be considered as a screening tool.