Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project

Preventive Medicine Reports

Anna M. Dyrvig Kristensen¹  Manan Pareek²  Frank Kee³  Allan Linneberg⁴  Marie Moitry⁵  Chiara Donfrancesco⁶  Guido Grassi⁷  Susana Sans⁸  Simona Giampaoli⁹  Peter M Nilsson^1,10  Thomas S.G. Sehested^1,10  Victoria Rosberg^1,10  Julie KK Vishram-Nielsen^1,11  Wojciech Drygas^1,12  Giancarlo Cesana^1,13  Giuseppe Mancia^1,13  Giovanni Veronesi^1,13  Hermann Brenner^1,14  Ben Schöttker^1,15  Luigi Palmieri^1,16  Annette Peters^1,17  Stefan Söderberg^1,18  Jean Dallongeville^1,18  Jean Ferrieres^1,18  Michael H Olsen^1,19  Tor Biering-Sørensen^2,20  Abdonas Tamosiunas^2,21  Sameline Grimsgaard^2,22  Tarja Palosaari^2,23  Veikko Salomaa^2,24  Kari Kuulasmaa^2,25 

[1] Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Frederiksberg, Denmark;Corresponding author at: Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA;Catalan Department of Health, Barcelona, Spain;Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Frederiksberg, Denmark;Centre for Public Health, The Queeńs University of Belfast, Northern Ireland;Clinica Medica, University Milano Bicocca, Monza, Italy;Department for Clinical Sciences Medicine, Lund University, Skane University Hospital, Malmö, Sweden;Department of Cardiology, North Zealand Hospital, Hillerød, Denmark;Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse Cedex 9, France;Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy;Department of Epidemiology and Public Health, University of Strasbourg and University Hospital of Strasbourg, Strasbourg, France;Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland;Department of Medicine, Zealand University Hospital, Roskilde, Denmark;Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden;Finnish Institute for Health and Welfare (THL), Helsinki, Finland;German Cancer Research Center (DKFZ), Heidelberg, Germany, Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany;Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany;Institut Pasteur de Lille, Lille Cedex, France;Lithuanian University of Health Sciences, Institute of Cardiology, Kaunas, Lithuania;Research Centre in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Italy;Research Centre on Public Health, University of Milano Bicocca, Villa Serena, Monza, Italy;University of Milano-Bicocca and Policlinico di Monza, Monza, Italy;

关键词: Adipose tissue;    Assessment, risk;    Body mass index;    Cardiovascular diseases;    Cholesterol;    Waist-hip ratio;   

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown