You are here
Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies.
Monday,2013-01-14 17:10 America/Los_Angeles — poolea2
| Title | Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. |
| Publication Type | Journal Article |
| Year of Publication | 2011 |
| Authors | Wormser, D, Kaptoge, S, Di Angelantonio, E, Wood, AM, Pennells, L, Thompson, A, Sarwar, N, Kizer, JR, Lawlor, DA, Nordestgaard, BG, Ridker, P, Salomaa, V, Stevens, J, Woodward, M, Sattar, N, Collins, R, Thompson, SG, Whitlock, G, Danesh, J |
| Corporate/Institutional Authors | Emerging Risk Factors Collaboration, |
| Journal | Lancet |
| Volume | 377 |
| Issue | 9771 |
| Pagination | 1085-95 |
| Date Published | 2011 Mar 26 |
| ISSN | 1474-547X |
| Keywords | Age Factors, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Cholesterol, Cholesterol, HDL, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Obesity, Abdominal, Proportional Hazards Models, Prospective Studies, Risk Assessment, Sex Factors, Smoking, Systole, Waist Circumference, Waist-Hip Ratio |
| Abstract | <p><b>BACKGROUND: </b>Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease.</p><p><b>METHODS: </b>We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4.56 kg/m(2) higher BMI, 12.6 cm higher waist circumference, and 0.083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios.</p><p><b>RESULTS: </b>Individual records were available for 221,934 people in 17 countries (14,297 incident cardiovascular disease outcomes; 1.87 million person-years at risk). Serial adiposity assessments were made in up to 63,821 people (mean interval 5.7 years [SD 3.9]). In people with BMI of 20 kg/m(2) or higher, HRs for cardiovascular disease were 1.23 (95% CI 1.17-1.29) with BMI, 1.27 (1.20-1.33) with waist circumference, and 1.25 (1.19-1.31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1.07 (1.03-1.11) with BMI, 1.10 (1.05-1.14) with waist circumference, and 1.12 (1.08-1.15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of -0.0001, -0.0001, and 0.0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement -0.19%, -0.05%, and -0.05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0.95, 95% CI 0.93-0.97) than for waist circumference (0.86, 0.83-0.89) or waist-to-hip ratio (0.63, 0.57-0.70).</p><p><b>INTERPRETATION: </b>BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.</p><p><b>FUNDING: </b>British Heart Foundation and UK Medical Research Council.</p> |
| DOI | 10.1016/S0140-6736(11)60105-0 |
| Alternate Journal | Lancet |
| PubMed ID | 21397319 |
| PubMed Central ID | PMC3145074 |
| Grant List | G0600705 / / Medical Research Council / United Kingdom PG/09/002/26056 / / British Heart Foundation / United Kingdom / / Medical Research Council / United Kingdom G1000143 / / Medical Research Council / United Kingdom MC_U137686857 / / Medical Research Council / United Kingdom UL1 TR000062 / TR / NCATS NIH HHS / United States G0401527 / / Medical Research Council / United Kingdom G0701113 / / Medical Research Council / United Kingdom UL1 RR025014 / RR / NCRR NIH HHS / United States G0701619 / / Medical Research Council / United Kingdom RG/08/014 / / British Heart Foundation / United Kingdom MC_U105260792 / / Medical Research Council / United Kingdom RG/08/014/24067 / / British Heart Foundation / United Kingdom |