Relationship Between Waist-to-Neck Circumference Ratio and Coronary Artery Calcium Score

Abstract

Aim: Coronary artery calcium score (CACS) is the leading parameter for detecting subclinical atherosclerosis. The waist-to-neck circumference ratio (WNR) is advantageous in determining visceral fat levels associated with atherosclerosis. In light of these findings, our study aimed to investigate the relationship between CACS and WNR. Material and Method: We conducted a cross-sectional study at a single center as part of our research. The study consists of 362 patients who visited the cardiology outpatient clinic from March to May 2024. They underwent multidetector coronary computed tomography and had their CACS calculated. After obtaining written consent from the patients, past disease histories, waist circumference, neck circumference, blood pressure, and laboratory parameters were recorded. Waist-to-neck circumference ratio was calculated. Patients were divided into two groups: CACS=0 and CACS >0. Results: Of all the patients, 70.7% (256 patients) had a CACS score of 0, with the remaining 29.3% (106 patients) having a CACS score greater than. The mean age in the group with CACS >0 was 52.85±8.79 years, and the mean age was statistically significantly higher (p<0.001). Waist-to-neck circumference ratio was statistically significantly higher in the group with CACS >0 (p<0.001). In logistic regression analyses, WNR emerged as a significant independent predictor of detecting the presence of CACS (p=0.001). The Receiver operating characteristic curve (ROC) analysis was performed to evaluate the ability of WNR to predict the presence of CACS, the area under the curve was determined as 0.665 (0.604–725), the cut-off was 2.75, the sensitivity was 67.9%, and the specificity was 67.2% (p<0.001). Conclusion: Our study found a significant relationship between WNR and the presence of CACS.

Keywords

• anthropometric measurements
• atherosclerosis
• waist-neck circumference ratio
• coronary artery calcium score

References

1. 1. Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology. 2012;264(3):637–49.
2. 2. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210–5.
3. 3. Wang J, Huang X, Fu C, Sheng Q, Liu P. Association between triglyceride glucose index, coronary artery calcification and multivessel coronary disease in Chinese patients with acute coronary syndrome. Cardiovasc Diabetol. 2022;21(1):187.
4. 4. Magalhaes EI, Sant’Ana LF, Priore SE, Franceschini Sdo C. [Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children]. Rev Paul Pediatr. 2014;32(3):273–81.
5. 5. Zhou J, Liu C, Zhou P, Li J, Chen R, Wang Y, et al. Prevalence and impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome. Nutr Metab Cardiovasc Dis. 2021;31(9):2693–2699.
6. 6. Katz SL, Vaccani JP, Barrowman N, Momoli F, Bradbury CL, Murto K. Does neck-to-waist ratio predict obstructive sleep apnea in children? J Clin Sleep Med. 2014;10(12):1303–8.
7. 7. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Jr., Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.
8. 8. Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012;98(3):177–84.

9. 9. Ahmadi A, Argulian E, Leipsic J, Newby DE, Narula J. From Subclinical Atherosclerosis to Plaque Progression and Acute Coronary Events: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;74(12):1608–1617.
10. 10. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45.
11. 11. Miller RJH, Han D, Singh A, Pieszko K, Slomka PJ, Gransar H, et al. Relationship between ischaemia, coronary artery calcium scores, and major adverse cardiovascular events. Eur Heart J Cardiovasc Imaging. 2022;23(11):1423–1433.
12. 12. Qiao T, Luo T, Pei H, Yimingniyazi B, Aili D, Aimudula A, et al. Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: a prospective cohort study. Cardiovasc Diabetol. 2022;21(1):225.
13. 13. Maddaloni E, Cavallari I, De Pascalis M, Keenan H, Park K, Manfrini S, et al. Relation of Body Circumferences to Cardiometabolic Disease in Overweight-Obese Subjects. Am J Cardiol. 2016;118(6):822–827.
14. 14. Dang AK, Truong MT, Le HT, Nguyen KC, Le MB, Nguyen LT, et al. Anthropometric Cut-Off Values for Detecting the Presence of Metabolic Syndrome and Its Multiple Components among Adults in Vietnam: The Role of Novel Indices. Nutrients. 2022;14(19).
15. 15. Gomez-Ambrosi J, Silva C, Galofre JC, Escalada J, Santos S, Millán D, et al. Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes (Lond) . 2012;36(2):286–94.
16. 16. Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;143(21):e984–e1010.
17. 17. Park J, Lee ES, Lee DY, Kim J, Park SE, Park CY, et al. Waist Circumference as a Marker of Obesity Is More Predictive of Coronary Artery Calcification than Body Mass Index in Apparently Healthy Korean Adults: The Kangbuk Samsung Health Study. Endocrinol Metab (Seoul) . 2016;31(4):559–566.
18. 18. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39–48.
19. 19. He Y, Chen J, Cao J, Hu Y, Li H, Lu J. Neck Circumference is Associated with Metabolic Syndrome Components in Chinese Subjects with Type 2 Diabetes. Diabetes Metab Syndr Obes. 2022;15:2781–2787.
20. 20. Saneei P, Shahdadian F, Moradi S, Ghavami A, Mohammadi H, Rouhani MH. Neck circumference in relation to glycemic parameters: a systematic review and meta-analysis of observational studies. Diabetol Metab Syndr. 2019;11:50.
21. 21. Tian P, Liu Y, Wang J, Xing L, Huang X, Fu C, et al. Correlation of neck circumference, coronary calcification severity and cardiovascular events in Chinese elderly patients with acute coronary syndromes. Atherosclerosis. 2024;394:117242. 2.
22. 22. Baena CP, Lotufo PA, Santos IS, Goulart AC, Bittencourt MS, Duncan BB, et al. Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium: Results from The ELSA-Brasil. Nutr Metab Cardiovasc Dis. 2016;26(3):216–22.
23. 23. Yano Y, O’Donnell CJ, Kuller L, Kavousi M, Erbel R, Ning H, et al. Association of Coronary Artery Calcium Score vs Age With Cardiovascular Risk in Older Adults: An Analysis of Pooled Population-Based Studies. JAMA Cardiol. 2017;2(9):986–994.
24. 24. Jung DH, Lee YJ, Ahn HY, Shim JY, Lee HR. Relationship of hepatic steatosis and alanine aminotransferase with coronary calcification. Clin Chem Lab Med. 2010;48(12):1829–34. 25. Jung DH, Lee HR, Lee YJ, Kim JK, Park BJ, Shim JY. The association between coronary artery calcification and mean platelet volume in the general population. Platelets. 2011;22(8):567–71.