Grace M. Egeland, Jannicke Igland, Ottar Nygard, Gerhard Sulo and Grethe S. Tell
Background: There has been growing research interest in exploring the utility of the hypertriglyceridemicwaist phenotype as a predictor of cardio-metabolic risk. To date, prospective studies evaluating the phenotype as a predictor of cardiovascular disease have provided variable results. Objectives: To evaluate the usefulness of the hypertriglyceridemic-waist phenotype as an independent predictor of acute myocardial infarction beyond classical cardiovascular disease risk factors in a homogeneous Norwegian population. Methods: Norwegian health survey (Cohort Norway) participants (n=116,111), free of heart disease in 1994- 2003, were followed through 2009 by record linkages to The Cause of Death Registry and hospital discharge diagnoses through the Cardiovascular disease in Norway project. Cox proportional hazards analyses adjusted for conventional risk factors. Results: During a mean follow-up of 11.5 yrs (SD=2.8), 3,624 participants developed an acute myocardial infarction. Prevalence of an enlarged waist (>102 cm for men, and >88 cm for women) increased from the lowest to highest quartile of triglycerides for men (4.9% to 22.5%) and women (6.5% to 42.1%; P for trend < 0.01). The presence of an enlarged waist and elevated triglyceride (>1.7 mmol/L) was associated with a hazard ratio for acute myocardial infarction of 1.68 (95% CI 1.48-1.90) for men and 1.95 (95% CI 1.66-2.29) for women compared to those with normal waist and triglyceride level after adjusting for age, smoking and time since last meal. However, 75% of the excess risk was mediated by HDL and nonHDL cholesterol. Conclusions: The phenotype is a useful global assessment tool but of limited value when conventional risk factors are available. Patients presenting with the phenotype should be targeted with lifestyle interventions and referred for clinical follow-up.
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