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| Home > Publications database > Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project. |
| Home > Publications database > Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project. |
| Journal Article | DKFZ-2022-00272 |
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2022
Elsevier
Amsterdam [u.a.]
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Please use a persistent id in citations: doi:10.1016/j.pmedr.2022.101700
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 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.
Keyword(s): ACM, all-cause mortality ; ASCVD, atherosclerotic cardiovascular disease ; AUCROC, area under the receiver-operating-characteristic curve ; Adipose tissue ; Assessment, risk ; BMI, body mass index ; BP, blood pressure ; Body mass index ; CEP, composite cardiovascular endpoint ; CI, confidence interval ; CV, cardiovascular ; CVD, cardiovascular disease ; CVM, cardiovascular mortality ; Cardiovascular diseases ; Chol, serum total cholesterol ; Cholesterol ; DBP, diastolic blood pressure ; EFM, estimated fat mass ; HDL-cholesterol, high density lipoprotein cholesterol ; HR, hazard ratio ; IQR, interquartile range ; MACE, major adverse cardiovascular events ; MBP, mean blood pressure ; MONICA, Multi-national MONItoring of Trends and Determinants in CArdiovascular Disease ; MORGAM, MOnica, Risk, Genetics, Archiving and Monograph ; NRI, net reclassification improvement ; NS, non-significant ; PP, pulse pressure ; SBP, systolic blood pressure ; SCORE, Systematic COronary Risk Evaluation ; WHR, waist-hip ratio ; Waist-hip ratio ; cNRI, continuous net reclassification improvement
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