Waist-hip ratio is a practical and valid predictor of CAD risk.

We were interested to read the recent commentary provided by Dr. Bronson regarding the practical value of waist–hip ratio (WHR) for office-based prediction of risk for heart disease (1). Although we wholeheartedly agree that such measures as computed tomography (CT), as shown by Goodpaster and colleagues (2), may be superior in quantifying visceral adipose tissue and hence better able to predict development of the metabolic syndrome, WHR should not yet be brushed aside. First, the association of WHR and risk for coronary artery disease is clear. Yusef and colleagues (3), in a case–control study evaluating 27 098 patients and spanning 52 countries, demonstrated that WHR shows a graded and highly significant association with myocardial infarction (MI) worldwide. WHR was shown to have a stronger association with MI risk than body mass index. This multinational study included both men and women across multiple ethnic groups, including people of Asian and South Asian descent. Second, standardization of measurement for WHR improves measurement reproducibility and allows for simple data collection in the medical office. Guidelines for measuring WHR are available on the Stanford School of Medicine Web site (4). We are currently using these guidelines in an ongoing obesity study at our institution, and we find that WHR measurements are highly reproducible among all members of our research team. Lastly, a nonstretchable 1.5-m tape measure costs around US $1.15. For overly obese patients, we spend a little more on the 3-m version (US $1.95). Besides the advantage of tape measurement being less invasive than CT scanning, cost comparison between the 2 tools makes the choice clear for our financially challenged research group. Rajmony Pannu, MD John E. Snyder, MS, MD New Hanover Regional Medical Center Wilmington, North Carolina, USA References 1. Bronson DL. Waist-to-hip ratio showed a linear association with mortality in middle-aged men and women, but body mass did not [Comment]. ACP J Club. 2007;147:79. Comment on: Simpson JA, MacInnis RJ, Peeters A, et al. A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study. Obesity. 2007;15:994-1003. 2. Goodpaster BH, Krishnaswami S, Harris TB, et al. Obesity, regional body fat distribution, and the metabolic syndrome in older men and women. Arch Intern Med. 2005;165:777-83. 3. Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640-9. 4. Stanford School of Medicine guidelines to measure WHR, 2007. http://pstlab.stanford.edu/PPG/measures/waisthip.html (accessed on 26 November 2007). L e t t e r