Original Article

Association of Body Mass Index and Waist Circumference with Subclinical Atherosclerosis in Retired NFL Players

Authors: Yashashwi Pokharel, MD, MSCR, Sukhdeep Basra, MD, MPH, Andrew E. Lincoln, ScD, MS, Andrew M. Tucker, MD, Vijay Nambi, MD, PhD, Khurram Nasir, MD, MPH, Robert A. Vogel, MD, Nathan D. Wong, PhD, Jeffrey L. Boone, MD, MS, Arthur J. Roberts, MD, Christie M. Ballantyne, MD, Salim S. Virani, MD, PhD


Objectives: It is unknown which measure of adiposity (body mass index [BMI] or waist circumference [WC]) is associated with subclinical atherosclerosis in retired National Football League (NFL) players and whether this relation is attenuated after adjusting for components of the metabolic syndrome (elevated triglycerides, fasting glucose, and low levels of high-density lipoprotein-cholesterol [HDL-C]) that frequently coexist with obesity.

Methods: Coronary artery calcium (CAC) was measured in 926 retired NFL players. BMI was calculated as weight (in kilograms)/height (in meters) 2 and WC was measured in inches. Logistic regression analyses adjusting for age, race, systolic blood pressure, high sensitivity C-reactive protein, triglycerides, HDL-C, and fasting blood glucose were performed to evaluate whether BMI or WC was independently associated with the presence of CAC (CAC score >0).

Results: The median age, BMI and WC were 54 years, 31 kg/m 2 , and 40 inches, respectively. CAC was present in 61% (n = 562) of retired players. Adjusting for age, race, systolic blood pressure, high sensitivity C-reactive protein, triglycerides, HDL-C, and fasting blood glucose, each standard deviation increase in BMI (4.85 kg/m 2 ) was significantly associated with CAC (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03–1.50), but each standard deviation increase in WC (10.53 inches) was not significantly associated with CAC (OR 1.18, 95% CI 0.96–1.45). There was a significant association for the presence of CAC for highest versus lowest quartiles of both BMI (OR 1.93, 95% CI 1.13–3.28) and WC (OR 1.75, 95% CI 1.05–2.92), although the trend for the presence of CAC was significant only across increasing BMI quartiles, even in models that included WC.

Conclusions: In retired NFL players both BMI and WC were associated with CAC. Higher BMI may be associated with an increasing trend for the presence of CAC independent of WC.

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