TY - JOUR

T1 - Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures

T2 - The MORGAM prospective cohort project

AU - Rosberg, Victoria

AU - Vishram-Nielsen, Julie KK

AU - Kristensen, Anna M.Dyrvig

AU - Pareek, Manan

AU - Sehested, Thomas S.G.

AU - Nilsson, Peter M.

AU - Linneberg, Allan

AU - Palmieri, Luigi

AU - Giampaoli, Simona

AU - Donfrancesco, Chiara

AU - Kee, Frank

AU - Mancia, Giuseppe

AU - Cesana, Giancarlo

AU - Veronesi, Giovanni

AU - Grassi, Guido

AU - Kuulasmaa, Kari

AU - Salomaa, Veikko

AU - Palosaari, Tarja

AU - Sans, Susana

AU - Ferrieres, Jean

AU - Dallongeville, Jean

AU - Söderberg, Stefan

AU - Moitry, Marie

AU - Drygas, Wojciech

AU - Tamosiunas, Abdonas

AU - Peters, Annette

AU - Brenner, Hermann

AU - Schöttker, Ben

AU - Grimsgaard, Sameline

AU - Biering-Sørensen, Tor

AU - Olsen, Michael H.

N1 - Publisher Copyright: © 2022 The Author(s)

PY - 2022

Y1 - 2022

N2 - To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.

AB - To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.

KW - Adipose tissue

KW - Assessment, risk

KW - Body mass index

KW - Cardiovascular diseases

KW - Cholesterol

KW - Waist-hip ratio

U2 - 10.1016/j.pmedr.2022.101700

DO - 10.1016/j.pmedr.2022.101700

M3 - Journal article

C2 - 35141116

AN - SCOPUS:85123786731

VL - 26

JO - Preventive Medicine Reports

JF - Preventive Medicine Reports

SN - 2211-3355

M1 - 101700

ER -