The hypertriglyceridemic waist phenotype among women


      Background: Elevated plasma triglycerides (TG) and waist girth (hypertriglyceridemic waist (HTGW)) has been associated with elevated insulin, small dense low-density lipoprotein (sLDL) particles, and Apo B in men. The HTGW has not been reported for women and the effect of cardiorespiratory fitness (“fitness”) on associations between HTGW and coronary risk factors is unknown. Purpose: To determine the prevalence of HTGW and the influence of fitness on the relationship between HTGW and coronary risk among 137 healthy women (54±9 year; body mass index (BMI)=28±6 kg/m2). Methods: HTGW was defined as waist girth >88 cm and TG >150 mg/dl. The metabolic triad was defined as insulin >31 pmol/l, Apo B >69 mg/dl and LDL-C >84 mg/dl. Fitness was assessed with a maximal treadmill exercise test. Results: The sample prevalence of HTGW (n=15) was 11% (95% CI=5.7–16.0%). Apo B (P=0.04) and insulin (P=0.0001) increased across quintiles of waist girth, and LDL-C (P=0.004) increased across quintiles of TG. Metabolic triad prevalence was highest (67%, n=10) among HTGW women and lowest (22%, n=26) among non-HTGW women. A trend for higher coronary heart disease CHD risk factors was observed among HTGW compared with non-HTGW women. Among the HTGW group, a trend for lower CHD risk factors was observed among fit (≥6.5 METs, n=7) versus unfit women (<6.5 METs, n=8). Sample size limitations prohibited meaningful tests of significant differences in CHD risk factors when stratified simultaneously on HTGW and fitness status. Conclusions: HTGW is associated with increased coronary risk factors similarly among women as reported for men. Higher fitness may improve the CHD risk profile among women with HTGW.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cooper R
        • Cutler J
        • Desvigne-Nickens P
        • et al.
        Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States.
        Circulation. 2000; 102: 3137-3147
      1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Pressure in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA. 2001;285:2486–97.

        • Mosca L
        • Manson J.E
        • Sutherland S.E
        • et al.
        Cardiovascular disease in women.
        Circulation. 1997; 96: 2468-2482
        • Mokdad A.H
        • Bowman B.A
        • Ford E.S
        • et al.
        The continuing epidemics of obesity and diabetes in the United States.
        JAMA. 2001; 286: 1195-1200
        • Ford E.S
        • Giles W.H
        • Dietz W.H
        Prevalence of the metabolic syndrome among US adults.
        JAMA. 2002; 287: 356-359
        • Meigs J.B
        • D’Agostino R.B
        • Wilson P.W.F
        • et al.
        Risk variable clustering in the insulin resistance syndrome.
        Diabetes. 1997; 46: 1594-1600
        • Trevisan M
        • Liu J
        • Bahsas F.B
        • et al.
        Syndrome X and mortality: a population-based study.
        Am. J. Epidemiol. 1998; 148: 958-966
        • Wilson P.F.W
        • Kannel W.B
        • Sibershatz H
        • D’Agostino R.B
        Clustering of metabolic factotrs and coronary heart disease.
        Arch. Intern. Med. 1999; 159: 1104-1109
        • Greenland P
        • Smith S.C
        • Grundy S.M
        Improving coronary heart disease risk assessment in asymptomatic people.
        Circulation. 2001; 104: 1863-1867
        • Lemieux I
        • Pascot A
        • Couillard C
        • et al.
        Hypertriglyceridemic waist. A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?.
        Circulation. 2000; 102: 179-184
        • Austin M.A
        • Hokanson J.E
        • Edwards K.L
        Hypertriglyceridemia as a cardiovascular risk factor.
        Am. J. Cardiol. 1998; 81: 7B-12B
        • Lissner L
        • Bjorkelund C
        • Heitmann B.L
        • et al.
        Larger hip circumference independently predicts health and longevity in a Swedish female cohort.
        Obes. Res. 2001; 9: 644-646
        • Boyko E.J
        • De Courten M
        • Zimmet P.Z
        • et al.
        Features of the metabolic syndrome predict higher risk of diabetes and impaired glucose tolerance.
        Diabetes Care. 2000; 23: 1242-1248
        • Riley P.L
        • Finnegan L.P
        The prevention research centers program: collaboration in women’s health.
        J. Women’s Health. 1997; 6: 281-283
        • Ainsworth B.E
        • Irwin M.L
        • Addy C.L
        • et al.
        Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study.
        J. Women’s Health. 1999; 8: 805-813
        • Drowatzky K.L
        • Durstine J.L
        • Irwin M.L
        • et al.
        The association between physical activity, cardiorespiratory fitness, and lipoprotein(a) concentrations in a tri-ethnic sample of women: The Cross-Cultural Activity Participation Study.
        Vascular Med. 2001; 6: 15-21
        • Irwin M.L
        • Mayer-Davis E.J
        • Addy C.L
        • et al.
        Moderate-intensity physical activity and fasting insulin levels in women.
        Diabetes Care. 2000; 23: 449-454
        • LaMonte M.J
        • Durstine J.L
        • Addy C.L
        • et al.
        Physical activity, physical fitness, and Framingham 10-year risk score: The Cross-Cultural Activity Participation Study.
        J. Cardiopulm Rehab. 2001; 21: 63-70
      2. National Heart, Lung, and Blood Institute. Clinical guidelines in the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Rockville, MD: National Institutes of Health, National Heart, Lung, and Blood Institute; 1998.

      3. Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;157:2413–45.

        • Kim E
        • Goldberg M
        Serum cholesterol assay using a stable Leibermann-Buchard reagent.
        Clin. Chem. 1969; 15: 1171-1179
        • Warnick G.R
        • Albers J.J
        A comprehensive evaluation of the heparin-manganese precipitation procedure for estimation of high-density lipoprotein.
        J. Lipid. Res. 1978; 19: 65-76
        • Freidewald W.T
        • Levy R.I
        • Fredrickson D.S
        Estimation of the concentration of low-density lipoprotein in plasma without the use of the preparative ultracentrifuge.
        Clin. Chem. 1972; 18: 499-502
      4. Tietz N (Ed.), Fundamentals of Clinical Chemistry. Philadelphia, PA: WB Saunders; 1986.

        • Laurell C.B
        Quantitative estimation of proetines by electrophoresis in agarose gel containing antibodies.
        Ann. Biochem. 1966; 15: 45-52
        • Rifai N
        • Tracy R.P
        • Ridker P.M
        Clinical efficacy of an automated high-sensitivity C-reactive protein assay.
        Clin. Chem. 1999; 45: 2136-2141
        • Campos H
        • Moye L.A
        • Glasser S.P
        • Stampfer M.J
        • Sacks F.M
        Low-density lipoprotein size, pravastatin, and coronary events.
        JAMA. 2001; 286: 1468-1474
        • Conway J.M
        • Yanovski S.Z
        • Avila N.A
        • Hubbard V.S
        Visceral adipose tissue differences in black and white women.
        Am. J. Clin. Nutr. 1995; 61: 765-771
        • LaMarche B
        • Tchernof A
        • Mauriege P
        • et al.
        Fasting insulin, and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease.
        JAMA. 1998; 279: 1955-1961
        • LaMonte M.J
        • Durstine J.L
        • Yanowitz F.G
        • et al.
        Cardiorespiratory fitness and C-reactive protein among a tri-ethnic sample of women.
        Circulation. 2002; 106: 403-406
        • Ridker P.M
        • Hennekens C.H
        • Buring J.E
        • et al.
        C-reactive protein and other markers of inflammation in prediction of cardiovascular disease in women.
        N. Engl. J. Med. 2000; 342: 836-843
        • Pradhan A.D
        • Manson J.E
        • Rifai N
        • et al.
        C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus.
        JAMA. 2001; 286: 327-334
        • Pearson T.A
        • Blair S.N
        • Daniels S.R
        • et al.
        AHA guidelines for primary prevention fo cardiovascular disease and stroke: 2002 update.
        Circulation. 2002; 106: 388-391
        • Smith S.C
        • Blair S.N
        • Bonow R.O
        • et al.
        AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update.
        Circulation. 2001; 104: 1577-1579