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

Rosberg, Victoria ; Vishram-Nielsen, Julie KK ; Kristensen, Anna M.Dyrvig ; Pareek, Manan ; Sehested, Thomas S.G. ; Nilsson, Peter M. LU ; Linneberg, Allan ; Palmieri, Luigi ; Giampaoli, Simona and Donfrancesco, Chiara , et al. (2022) In Preventive Medicine Reports 26.
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adipose tissue, Assessment, risk, Body mass index, Cardiovascular diseases, Cholesterol, Waist-hip ratio
in
Preventive Medicine Reports
volume
26
article number
101700
publisher
Elsevier
external identifiers
  • pmid:35141116
  • scopus:85123786731
ISSN
2211-3355
DOI
10.1016/j.pmedr.2022.101700
language
English
LU publication?
yes
id
4c6847c4-da90-4805-b47d-e596f0b0f318
date added to LUP
2022-03-24 16:40:48
date last changed
2024-04-18 06:15:23
@article{4c6847c4-da90-4805-b47d-e596f0b0f318,
  abstract     = {{<p>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 (AUC<sub>ROC</sub>), 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 (&lt;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 (AUC<sub>ROC</sub> difference; P &lt; 0.001). In subjects &lt; 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 &lt; 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.</p>}},
  author       = {{Rosberg, Victoria and Vishram-Nielsen, Julie KK and Kristensen, Anna M.Dyrvig and Pareek, Manan and Sehested, Thomas S.G. and Nilsson, Peter M. and Linneberg, Allan and Palmieri, Luigi and Giampaoli, Simona and Donfrancesco, Chiara and Kee, Frank and Mancia, Giuseppe and Cesana, Giancarlo and Veronesi, Giovanni and Grassi, Guido and Kuulasmaa, Kari and Salomaa, Veikko and Palosaari, Tarja and Sans, Susana and Ferrieres, Jean and Dallongeville, Jean and Söderberg, Stefan and Moitry, Marie and Drygas, Wojciech and Tamosiunas, Abdonas and Peters, Annette and Brenner, Hermann and Schöttker, Ben and Grimsgaard, Sameline and Biering-Sørensen, Tor and Olsen, Michael H.}},
  issn         = {{2211-3355}},
  keywords     = {{Adipose tissue; Assessment, risk; Body mass index; Cardiovascular diseases; Cholesterol; Waist-hip ratio}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Preventive Medicine Reports}},
  title        = {{Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures : The MORGAM prospective cohort project}},
  url          = {{http://dx.doi.org/10.1016/j.pmedr.2022.101700}},
  doi          = {{10.1016/j.pmedr.2022.101700}},
  volume       = {{26}},
  year         = {{2022}},
}