Waist Circumference predicting Cardiovascular Disease in Korean Men and Women Running title: Waist Circumference and Cardiovascular Disease

Objective: Obesity and cardiovascular disease (CVD) are closely related and have become increasingly prevalent in Korea. Asians are more prone to obesity-related co-morbidities than Caucasians, even at lower body mass index (BMI) and/or smaller waist circumference (WC) values. Nevertheless, little is known regarding the association of WC with the risk of CVD in non-Caucasian populations. The authors conducted a prospective cohort study of WC and the risk of CVD in the Korean Heart Study. Methods: We examined the association of WC to CVD incidence among 53,026 Korean adults (30,152 men, 22,874 women) with no history of CVD and/or cancer. During a mean follow-up of 8.6 years, 2,722 incident cases of atherosclerotic cardiovascular disease (ASCVD) including 1,383 cases of ischemic heart disease (IHD) and 1,012 cases of stroke were documented. Results: Average WC at baseline was 84.0±8.2 cm in men and 75.2±8.9 cm in women. After adjustment for age and BMI, WC was significantly associated with cardiovascular risk factors (P <.001). In men, a WC of ≥91 cm was associated with an ASCVD hazard ratio (HR) of 1.62 (95% confidence interval (CI): 1.25, 2.10) and an IHD HR of 1.70 (95% CI: 1.19, 2.42) in comparison with a WC of <78 cm even after further adjustment for BMI and traditional risk factors (P for trend = 0.0118, 0.0139 respectively). In women, the progressive associations of WC with ASCVD, IHD and stroke were observed. These associations were however attenuated after further adjustment for BMI and traditional risk factors. The multivariable HRs for ASCVD, IHD, and stroke increased with higher WC in both men and women. Conclusions: Central obesity significantly and independently contributes to cardiovascular outcomes in Korean men and women.