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Editor's Correspondence
January 28, 2008

Waist to Hip Ratio as a Supplement to Body Mass Index—Reply

Arch Intern Med. 2008;168(2):238. doi:10.1001/archinternmed.2007.62

In reply

We appreciate Hartz and Rimm for their comments on our results regarding BMI, waist circumference, and WHR and the risk of total and type-specific stroke.1 We agree with their first comment that the article would be valuable if more than 1 obesity indicator were included in the same regression equation. We have reanalyzed our data and included both BMI and WHR in the multivariate model. After adjustment for age, study year, smoking, and WHR, hazard ratios of ischemic stroke among subjects who were underweight (BMI [calculated as weight in kilograms divided by height in meters squared] <18.5), overweight (BMI, 25.0-29.9), and obese (BMI ≥30.0) were 0 (no ischemic cases), 1.41 (95% confidence interval [CI], 0.96-2.07), and 1.75 (95% CI, 1.12-2.76), respectively, among men, and 5.94 (95% CI, 2.11-16.7), 1.26 (95% CI, 0.84-1.90), and 1.75 (95% CI, 1.11-2.74), respectively, among women, compared with men and women with normal weight (BMI, 18.5-24.9). The joint association of BMI and WHR with the risk of ischemic stroke is also shown in the Figure. After adjustment for age, study year, and smoking, the positive trend of WHR on the risk of ischemic stroke was found at different levels of BMI only among men.

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