Xiaoya Li,1,* Tingting Hu,1,* Yiting Xu,1,* Xuhong Lu,1 Yingying Su,1 Yunfeng Xiao,2 Yufei Wang,1 Xiaojing Ma,1 Yuqian Bao1 

1Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China; 2Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yuqian Bao, Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, 600 Yishan Road, Shanghai, 200233, People’s Republic of China, Tel +86-21-64369181, Fax +86-21-64368031, Email yqbao@sjtu.edu.cn Xiaojing Ma, Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, 600 Yishan Road, Shanghai, 200233, People’s Republic of China, Tel +86-21-64369181, Fax +86-21-64368031, Email maxiaojing@sjtu.edu.cn

Aim: Obesity contributes to cardiovascular (CV) events. This study aimed to identify the most effective anthropometric indicators that add predictive value to body mass index (BMI) for subsequent CV events in individuals without carotid plaques, improving early risk stratification in subclinical populations.
Methods: This longitudinal study enrolled 1043 participants from a community-based cohort in Shanghai (2013– 2014) and followed them for CV events through 2021– 2022. The CV events included ischemic heart disease (myocardial infarction, unstable angina pectoris, hospitalization for heart failure, and coronary revascularization), ischemic stroke, and CV death. Carotid plaque was excluded via ultrasound. Visceral fat area (VFA) was assessed using magnetic resonance imaging. The neck circumference (NC), neck-to-height ratio (NHtR), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), neck-to-limb length ratio (NLR), and waist-to-limb length ratios (WLR) were calculated.
Results: Multivariable linear regression analysis revealed a significant positive correlation between various obesity-related indices (BMI, waist circumference, NC, NHtR, WHtR, WHR, NLR, and WLR) and VFA (all P < 0.001). Over a mean follow-up period of 7.6 years, 97 CV events (9.3%) were recorded. Cox proportional hazards regression demonstrated that elevated NLR was significantly associated with an increased CV risk with hazard ratios of 1.28 (95% confidence interval [CI]: 1.08– 1.52). Notably, the NLR significantly improved the predictive capacity of CV events (C-statistic, 0.671 [95% CI: 0.616– 0.726], P = 0.002; NRI, 0.090 [95% CI: 0.003– 0.177], P < 0.001; IDI, 0.007 [95% CI: 0.000– 0.019], P < 0.001).
Conclusion: NLR was correlated with visceral fat content, and significantly enhanced the predictive value of BMI for CV risk in individuals without baseline carotid plaque. These findings support their use in routine clinical assessment to enhance early prevention efforts.

Keywords: obesity, cardiovascular disorder, body mass index, visceral fat, neck-to-height ratio, neck-to-limb length ratio