BMC Public Health. 2025 Aug 2;25(1):2628. doi: 10.1186/s12889-025-23891-x.
ABSTRACT
BACKGROUND: With rising obesity and hypertension rates, cardiovascular disease and mortality issues have become increasingly severe. The weight-adjusted waist circumference index (WWI) is an innovative metric that accurately reflects body composition and shows superior potential in predicting obesity-related health risks. This study aims to explore the association between WWI and all-cause and cardiovascular mortality in hypertensive patients.
METHODS: Adult participants with hypertension were included from the National Health and Nutrition Examination Survey (2003-2016). Cox regression models and restricted cubic splines (RCSs) were used to assess the relationship between WWI and mortality. Stratified, interaction, and sensitivity analyses further examined the robustness of the results. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of WWI for mortality.
RESULTS: This study included 14,350 hypertensive individuals. As WWI levels increased, the risk of all-cause and cardiovascular mortality rose progressively. Each one-unit increase in WWI was associated with a 19% higher risk of all-cause mortality and a 23% higher chance of cardiovascular mortality in the fully adjusted continuous model. The highest WWI quartile had an increased risk of all-cause mortality (HR 1.38, 95% CI 1.21-1.57, P for trend < 0.001) and cardiovascular mortality (HR 1.70; 95% CI 1.28-2.25, P for trend = 0.005). Furthermore, RCS analysis revealed a nonlinear association between WWI and all-cause mortality (P-non-linear < 0.001). Stratified and interaction analyses confirmed that these associations were consistent and stable in various demographics, except for the diabetic population. Sensitivity analyses further confirmed these results. ROC analysis indicated that WWI had a higher predictive capability for all-cause and cardiovascular mortality than body mass index, waist circumference, and waist-to-height ratio.
CONCLUSION: This study provides new evidence for the association of WWI with all-cause and cardiovascular mortality in hypertensive patients. WWI may serve as a valuable indicator of adiposity risk in this population.
PMID:40753426 | DOI:10.1186/s12889-025-23891-x
