Waist-to-Hip Ratio is the Most Significant Health Risk Indicator in This Patient
Among the available options, waist-to-hip ratio (WHR) is the most significant indicator of health risk for this obese woman, as it provides superior prediction of cardiovascular mortality and metabolic risk compared to other anthropometric measures when weight is unavailable for BMI calculation. 1
Rationale for Prioritizing WHR Over Other Measures
Why WHR Outperforms the Available Alternatives
WHR carries the most important prognostic information for identifying adults at increased risk of cardiovascular and all-cause mortality, particularly in women. 2 The evidence demonstrates that:
Men and women who died of cardiovascular disease had greater WHR at baseline, and WHR was independently associated with cardiac events even after adjusting for demographic factors, lifestyle characteristics, and baseline cardiovascular disease risk factors. 2, 1
WHR showed a 95% increased risk of cardiovascular events when comparing extreme quantiles (RR = 1.95% CI: 1.55-2.44), which was numerically superior to waist circumference alone (RR = 1.63,95% CI: 1.31-2.04). 3
For every 0.01 unit increase in WHR, cardiovascular disease risk increases by 5%, compared to only 2% per 1 cm increase in waist circumference. 3
Why Not Waist Circumference Alone (Option D)
While waist circumference is valuable and easier to measure, WHR provides additional critical information by accounting for body fat distribution that waist circumference alone misses. 2 Specifically:
In patients with chronic kidney disease, WHR (but not waist circumference) was associated with cardiac events in fully adjusted models. 2, 1
Waist and hip circumferences have independent and opposite effects on cardiovascular risk factors—a narrow hip circumference (adjusted for waist) is independently associated with adverse metabolic profiles including high triglycerides and insulin levels. 4
WHR adjusts for ethnic differences in body shape, providing more uniform cardiovascular risk assessment across diverse populations, whereas optimal waist circumference cutpoints vary significantly by ethnicity. 1
Why Not BMI (Option B)
BMI cannot be calculated in this patient because weight was not provided, making this option clinically unavailable. 2 Even if weight were available:
BMI was not independently associated with cardiovascular mortality in fully adjusted models, while WHR maintained its predictive value. 5
In women specifically, WHR and waist circumference were superior predictors of cardiovascular death compared to BMI. 2
BMI does not account for body fat distribution, which is an independent risk factor for cardiovascular outcomes. 2
Why Not High LDL Alone (Option A)
While elevated LDL is certainly a cardiovascular risk factor, the question asks for the most significant indicator among anthropometric and lipid measures in the context of an obese patient with available waist and hip measurements. The evidence framework prioritizes:
WHR provides risk stratification that is independent of and additive to traditional lipid risk factors. 2
In non-Asian populations, WHR has a stronger association with dyslipidemia than BMI, suggesting it captures metabolic risk that encompasses lipid abnormalities. 2, 1
The patient has normal HDL, which partially mitigates the isolated high LDL risk, whereas central obesity measured by WHR predicts cardiovascular events independent of lipid profiles. 2, 1
Clinical Application in This Patient
For this obese woman with available waist and hip measurements, calculate the WHR immediately (waist circumference in cm divided by hip circumference in cm). 2, 1
Risk Interpretation
WHR values indicating increased cardiovascular risk require clinical action—the evidence shows that higher WHR quintiles confer up to 66% increased risk of cardiovascular mortality. 5
WHR provides stronger discrimination for type 2 diabetes risk in women compared to other anthropometric measures, which is particularly relevant given the association between obesity and diabetes development. 2, 1
The combination of high LDL and elevated WHR represents compounded cardiovascular risk that warrants aggressive risk factor modification. 2, 3
Important Clinical Caveats
WHR requires accurate measurement technique—waist should be measured at the midpoint between the lowest rib and iliac crest, and hip at the point of maximum circumference around the buttocks. 1 Measurement error can significantly affect risk classification.
While the American Heart Association does not recommend routine WHR use in general practice due to measurement complexity, the evidence clearly demonstrates WHR's superiority for mortality prediction, particularly when weight is unavailable for BMI calculation. 1
Gender-specific interpretation is critical—the predictive value and optimal cutpoints for WHR differ between men and women, with some evidence suggesting stronger associations in women for certain outcomes. 2