Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies
- PMID: 21397319
- PMCID: PMC3145074
- DOI: 10.1016/S0140-6736(11)60105-0
Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies
Abstract
Background: 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.
Methods: 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.
Results: 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).
Interpretation: 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.
Funding: British Heart Foundation and UK Medical Research Council.
Copyright © 2011 Elsevier Ltd. All rights reserved.
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Comment in
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Size still matters…but not in the way we once thought.Lancet. 2011 Mar 26;377(9771):1051-2. doi: 10.1016/S0140-6736(11)60239-0. Lancet. 2011. PMID: 21397321 No abstract available.
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Risk factors: little need to incorporate obesity measures in calculations of cardiovascular disease risk.Nat Rev Cardiol. 2011 May;8(5):241. doi: 10.1038/nrcardio.2011.52. Epub 2011 Mar 29. Nat Rev Cardiol. 2011. PMID: 21451470 No abstract available.
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Cardiovascular endocrinology: Cardiovascular risk-general versus abdominal adiposity.Nat Rev Endocrinol. 2011 Jun;7(6):312. doi: 10.1038/nrendo.2011.62. Epub 2011 Apr 12. Nat Rev Endocrinol. 2011. PMID: 21487431 No abstract available.
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Body-mass index, abdominal adiposity, and cardiovascular risk.Lancet. 2011 Jul 16;378(9787):226-7; author reply 228. doi: 10.1016/S0140-6736(11)61120-3. Lancet. 2011. PMID: 21763930 No abstract available.
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Body-mass index, abdominal adiposity, and cardiovascular risk.Lancet. 2011 Jul 16;378(9787):227; author reply 228. doi: 10.1016/S0140-6736(11)61121-5. Lancet. 2011. PMID: 21763933 No abstract available.
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