Diabetes & Metabolism Journal

Original Article

Cardiovascular Risk/Epidemiology
High Waist-to-Height Ratio Increases the Risk of Cardiovascular Outcomes in Adults with Type 1 Diabetes Mellitus: A Nationwide Cohort Study: Kyeong-Jin Kim, Seohyun Kim, Rosa Oh, So Hyun Cho, Myunghwa Jang, You-Bin Lee, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Ji Yoon Kim, Jae Hyeon Kim; Diabetes Metab J. 2026;50(4):739-751. Published online September 4, 2025; DOI: https://doi.org/10.4093/dmj.2025.0179

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Background
Central obesity contributes to an increased risk of cardiovascular disease (CVD) and mortality. The waist-to-height ratio (WHtR) is a practical marker of central obesity across sexes, ages, and ethnicities. However, its association with comprehensive cardiovascular (CV) outcomes in patients with type 1 diabetes mellitus (T1DM) remains unclear.
Methods
From a nationwide cohort database (2006–2020), 16,928 Korean adults with T1DM were included. Participants were categorized according to WHtR using three criteria: a three-group classification (<0.5, 0.5 to <0.6, and ≥0.6) and two binary classifications (≥0.5 vs. <0.5; ≥0.6 vs. <0.6). The primary outcome was a composite CV event, including heart failure (HF), myocardial infarction (MI), ischemic stroke, and CVD-related death, with each component analyzed as a secondary outcome.
Results
During a median follow-up of 6.7 years (interquartile range, 5.2 to 8.8), 4,293 composite CV events occurred. Compared with the WHtR <0.5 group, the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the composite CV outcome were 1.14 (1.05 to 1.24) in the WHtR 0.5 to <0.6 group and 1.62 (1.38 to 1.90) in the WHtR ≥0.6 group (P for trend <0.001). Increasing trends in aHRs were noted with rising WHtR values for each component of the composite outcome. Compared with the WHtR <0.6 group, the aHRs for the WHtR ≥0.6 group were as follows: HF, 1.49 (95% CI, 1.28 to 1.73); MI, 1.31 (95% CI, 1.02 to 1.68); ischemic stroke, 1.24 (95% CI, 1.02 to 1.51); and CVD-related death, 2.09 (95% CI, 1.49 to 2.92).
Conclusion
High WHtR was associated with an increased risk of CV events in adults with T1DM.

Citations

Citations to this article as recorded by

A CVD Classification Model for Individuals With Obesity: Multi‐Ethnic Validation Based on Multiple Metabolic Indicators
Runmin Cao, Yurun Zhang, Ling Cao, Honghe Jiang
Obesity.2026;[Epub] CrossRef

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