Maturitas 81 (2015) 99

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Letter to the Editor Waist-to-hip ratio as an indicator of atherosclerosis among women at risk Keywords: Waist-to-ratio Atherosclerosis Cardiovascular disease Postmenopausal Premenopausal

In a recent article in the Maturitas, Lee et al. reported that waistto-hip ratio (WHR) had a higher potential for predicting subclinical atherosclerosis compared to other anthropometric indices including body mass index and waist circumference in postmenopausal women [1]. Their study was well designed, sufficiently powered and allowed comparisons to premenopausal women. Although the receiver operating characteristic curve analysis successfully estimated the presence of carotid atherosclerosis according to anthropometric variables in that study, using a previously defined threshold value for WHR and running a regression analysis to identify whether a reduced WHR was an independent predictor of increased carotid intima-media thickness would be more attractive for both researchers and clinicians. A threshold for WHR for Asian women was suggested to be around 0.8 [2] but some other proposed values could also be used [3] and discussed for a better understanding. In a recent study on a selected group of polycystic ovary syndrome that is associated with clinical atherosclerotic diseases after menopause [4], we identified WHR as an independent predictor of a lower ankle brachial index (ABI) [5]. ABI is a useful tool to detect systemic atherosclerosis and peripheral arterial disease which are equally prevalent in middle aged women and men [6,7]. To sum, it appears that, by simply measuring waist and hip circumferences, both pre-menopausal and postmenopausal women will be able to estimate their own risk of atherosclerotic vascular diseases in the near future. 1. Conflict of interest statement The authors declare no conflict of interest.

DOI of original article: http://dx.doi.org/10.1016/j.maturitas.2014.12.015. http://dx.doi.org/10.1016/j.maturitas.2015.02.006 0378-5122/© 2015 Published by Elsevier Ireland Ltd.

References [1] Lee HJ, Hwang SY, Hong HC, et al. Waist-to-hip ratio is better at predicting subclinical atherosclerosis than body mass index and waist circumference in postmenopausal women. Maturitas 2015. pii:S0378-5122(14)00405-8. [2] Huxley R, James WP, Barzi F, et al. Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension. Obes Rev 2008;9(Suppl. 1):53–61. [3] Park SH, Choi SJ, Lee KS, Park HY. Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults. Circ J 2009;73:1643–50. [4] Lambrinoudaki I. Cardiovascular risk in postmenopausal women with the polycystic ovary syndrome. Maturitas 2011;68:13–6. [5] Dogan MI, Tasci I, Bulucu F, et al. Abdominal obesity is associated with a lower ankle-brachial index in women with polycystic ovary syndrome. Angiology 2013;64:105–11. [6] Aronow WS. Peripheral arterial disease in women. Maturitas 2009;64:204–11. [7] Bozkurt AK, Tasci I, Tabak O, Gumus M, Kaplan Y. Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis – CAREFUL study: a national, multi-center, cross-sectional observational study. BMC Cardiovasc Disord 2011;11:4.

Ilker Tasci ∗ Department of Internal Medicine, Gulhane School of Medicine, 06018 Ankara, Turkey Seyit Temel Ceyhan Department of Obstetrics and Gynecology, Gulhane School of Medicine, 06018 Ankara, Turkey Kenan Saglam Department of Internal Medicine, Gulhane School of Medicine, 06018 Ankara, Turkey ∗ Corresponding author at: Gulhane School of Medicine, Department of Internal Medicine, Etlik, 06018 Ankara, Turkey. Tel.: +90 312 3043119; fax: +90 312 3044000. E-mail addresses: [email protected], [email protected] (I. Tasci).

8 February 2015

Waist-to-hip ratio as an indicator of atherosclerosis among women at risk.

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