Association of Waist-Hip Ratio to Sudden Cardiac Death and Severe Coronary Atherosclerosis in Medicolegal Autopsies

Various modifiable and nonmodifiable risk factors, such as abdominal obesity, are known to affect the development of atherosclerotic cardiovascular disease and subsequent sudden cardiac death (SCD). The waist-hip ratio is a surrogate marker of visceral obesity that has been shown in various studies to be a better predictor of cardiovascular risk than the body mass index (BMI), a measurement of generalized obesity. Waist-hip ratio was measured prospectively on medicolegal autopsies performed for 1 year, in addition to standard measurements of BMI and heart weight, and histologic determination of severe coronary atherosclerosis (SCA, coronary artery diameter stenosis >75%). Logistic modeling was performed to determine any association between WHR, BMI, cardiovascular disease risk factors, heart weight, and SCD or SCA. Waist-hip ratio was not shown to be statistically significantly associated with either SCD (P = 0.68) or SCA (P = 0.14). Body mass index was shown to be significantly associated with SCA (P < 0.001), and heart weight was shown to be significantly associated with both SCD and SCA (P < 0.001, both). Waist-hip ratio, as a surrogate marker of central obesity and increased risk of atherosclerotic cardiovascular disease, is shown not to be statistically significantly associated with either SCD or SCA in postmortem cases.