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Original Investigation
February 14, 2017

Genetic Association of Waist-to-Hip Ratio With Cardiometabolic Traits, Type 2 Diabetes, and Coronary Heart Disease

Author Affiliations
  • 1Center for Genomic Medicine and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston
  • 2Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
  • 3Department of Economics, Massachusetts Institute of Technology, Cambridge
JAMA. 2017;317(6):626-634. doi:10.1001/jama.2016.21042
Key Points

Question  Is genetic evidence consistent with a causal relationship among waist-to-hip ratio adjusted for body mass index (a measure of abdominal adiposity), type 2 diabetes, and coronary heart disease?

Findings  In this mendelian randomization study, a polygenic risk score for increased waist-to-hip ratio adjusted for body mass index was significantly associated with adverse cardiometabolic traits and higher risks for both type 2 diabetes and coronary heart disease.

Meaning  These results provide evidence supportive of a causal association between abdominal adiposity and the development of type 2 diabetes and coronary heart disease.

Abstract

Importance  In observational studies, abdominal adiposity has been associated with type 2 diabetes and coronary heart disease (CHD). Whether these associations represent causal relationships remains uncertain.

Objective  To test the association of a polygenic risk score for waist-to-hip ratio (WHR) adjusted for body mass index (BMI), a measure of abdominal adiposity, with type 2 diabetes and CHD through the potential intermediates of blood lipids, blood pressure, and glycemic phenotypes.

Design, Setting, and Participants  A polygenic risk score for WHR adjusted for BMI, a measure of genetic predisposition to abdominal adiposity, was constructed with 48 single-nucleotide polymorphisms. The association of this score with cardiometabolic traits, type 2 diabetes, and CHD was tested in a mendelian randomization analysis that combined case-control and cross-sectional data sets. Estimates for cardiometabolic traits were based on a combined data set consisting of summary results from 4 genome-wide association studies conducted from 2007 to 2015, including up to 322 154 participants, as well as individual-level, cross-sectional data from the UK Biobank collected from 2007-2011, including 111 986 individuals. Estimates for type 2 diabetes and CHD were derived from summary statistics of 2 separate genome-wide association studies conducted from 2007 to 2015 and including 149 821 individuals and 184 305 individuals, respectively, combined with individual-level data from the UK Biobank.

Exposures  Genetic predisposition to increased WHR adjusted for BMI.

Main Outcomes and Measures  Type 2 diabetes and CHD.

Results  Among 111 986 individuals in the UK Biobank, the mean age was 57 (SD, 8) years, 58 845 participants (52.5%) were women, and mean WHR was 0.875. Analysis of summary-level genome-wide association study results and individual-level UK Biobank data demonstrated that a 1-SD increase in WHR adjusted for BMI mediated by the polygenic risk score was associated with 27-mg/dL higher triglyceride levels, 4.1-mg/dL higher 2-hour glucose levels, and 2.1–mm Hg higher systolic blood pressure (each P < .001). A 1-SD genetic increase in WHR adjusted for BMI was also associated with a higher risk of type 2 diabetes (odds ratio, 1.77 [95% CI, 1.57-2.00]; absolute risk increase per 1000 participant-years, 6.0 [95% CI, CI, 4.4-7.8]; number of participants with type 2 diabetes outcome, 40 530) and CHD (odds ratio, 1.46 [95% CI, 1.32-1.62]; absolute risk increase per 1000 participant-years, 1.8 [95% CI, 1.3-2.4]; number of participants with CHD outcome, 66 440).

Conclusions and Relevance  A genetic predisposition to higher waist-to-hip ratio adjusted for body mass index was associated with increased risk of type 2 diabetes and coronary heart disease. These results provide evidence supportive of a causal association between abdominal adiposity and these outcomes.

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