- BACKGROUND: Diabetes worsens the prognosis of patients with ischemic cardiovascular disease (ICVD). Increased body weight and abdominal obesity have been shown to increase the risk of diabetes in people without ICVD. Such a relationship has not been assessed in patients with ICVD who may have a different occurrence due to their disease and medications. OBJECTIVE: To examine the risk of developing diabetes among patients with ICVD according to body mass index (BMI), waist-to-hip ratio and waist circumference METHODS: Anthropometric measurements were done in 4699 men and 1187 women with ICVD (mean age 66 years) and without known diabetes at entry to the Heart Outcomes Prevention Evaluation (HOPE) study. During the median 4.5-year follow-up, a diagnosis of diabetes was reported in 261 (4.4%) participants. RESULTS: There was a positive and graded association between increased BMI, waist circumference and waist-to-hip ratio, and the risk of developing diabetes (P for trends <0.0001). After adjusting for all baseline characteristic differences including medications, the relative risk of developing diabetes after the first 40th percentile of each anthropometric measure increased by 12% (95% CI 9% to 15%) for every 1 kg/m2 increase in BMI; the relative risk increased by 5% (95% CI 4% to 6%) for every 1 cm increase in waist circumference and by 38% (95% CI 18% to 61%) for every 0.1 unit increase in waist-to-hip ratio. CONCLUSION: In patients with ICVD, increased BMI, waist-to-hip ratio and particularly waist circumference constitute independent risk factors for development of diabetes.