Frequency of Increased Body Mass Index and Waist–Hip Ratio in Patients Presenting with First-Time Acute Coronary Syndrome at a Tertiary Care Hospital in Karachi

Objectives: Obesity is a major modifiable risk factor for acute coronary syndrome (ACS), particularly in South Asian populations where central adiposity is highly prevalent. Although body mass index (BMI) is widely used to assess obesity, waist–hip ratio (WHR) may provide superior insight into cardiovascular risk due to its ability to reflect fat distribution. This study aimed to determine the frequency of increased BMI and WHR among patients presenting with first-time ACS and to evaluate their association with established cardiovascular risk factors. Methodology: This descriptive cross-sectional study included 184 patients presenting with a first episode of ACS at a tertiary care hospital in Karachi between August 2025 and November 2025. Demographic, clinical, and anthropometric data were collected using standardized methods. Elevated BMI was defined as ≥25 kg/m², and increased WHR was defined as >0.90 for males and >0.85 for females, in accordance with South Asian criteria. Associations between anthropometric measures and cardiovascular risk factors were analyzed using chi-square tests, with a p-value of ≤0.05 considered statistically significant. Results: The mean age of participants was 54.5 ± 10.2 years, and 60.3% were male. Elevated BMI was observed in 70.1% of patients, while 59.8% had increased WHR. Both elevated BMI and WHR were significantly associated with older age (p=0.01). Increased WHR showed significant associations with male gender (p=0.01) and hypertension (p=0.002), while smoking demonstrated a significant inverse association (p=0.01). BMI did not show statistically significant associations with these cardiovascular risk factors. Conclusion: A high prevalence of both generalized and central obesity was observed among patients presenting with first-time ACS. WHR demonstrated stronger and more consistent associations with key cardiovascular risk factors than BMI, supporting its routine use in cardiovascular risk assessment, particularly in South Asian populations.