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Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study

International Journal of Obesity volume 37, pages 1579–1585 (2013)Cite this article

Subjects

Abstract

Objectives:

The aim of this study was to compare novel and established anthropometrical measures in their ability to predict cardiovascular disease (CVD), and to determine whether they improve risk prediction beyond classical risk factors in a cohort study of 60-year-old men and women. We also stratified the results according to gender to identify possible differences between men and women. Furthermore, we aimed to replicate our findings in a large independent cohort (The Malmö Diet and Cancer study—cardiovascular cohort).

Methods:

This was a population-based study of 1751 men and 1990 women, aged 60 years and without CVD at baseline, with 375 incident cases of CVD during 11 years of follow-up. Weight, height, waist circumference (WC), hip circumference and sagittal abdominal diameter (SAD) were measured at baseline. Body mass index (BMI), waist–hip ratio (WHR), waist–hip-height ratio (WHHR), WC-to-height ratio (WCHR) and SAD-to-height ratio (SADHR) were calculated.

Results:

All anthropometric measures predicted CVD in unadjusted Cox regression models per s.d. increment (hazard ratios, 95% confidence interval), while significant associations after adjustments for established risk CVD factors were noted for WHHR 1.20 (1.08–1.33), WHR 1.14 (1.02–1.28), SAD 1.13 (1.02–1.25) and SADHR 1.17 (1.06–1.28). WHHR had higher increases in C-statistics, and model improvements (likelihood ratio tests (P<0.001)). In the replication study (MDC-CC, n=5180), WHHR was the only measure that improved Cox regression models in men (P=0.01).

Conclusion:

WHHR, a new measure reflecting body fat distribution, showed the highest risk estimates after adjustments for established CVD risk factors. These findings were verified in men but not women in an independent cohort.

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Acknowledgements

This study was supported by grants from the Stockholm County Council, Karolinska Institutet, the Swedish Heart and Lung Foundation, the Swedish Council for Working Life and Social Research, the Swedish Research Council (Longitudinal Research and K2005-27X-14278-04A), The Cardiovascular Program at Karolinska Institutet and the Strategic Support for Epidemiological Research at Karolinska Institutet.

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The study was investigator initiated and driven.

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Authors and Affiliations

  1. Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    A C Carlsson, K Leander, B Gigante & U de Faire

  2. Department of Neurobiology, Centre for Family Medicine, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

    A C Carlsson

  3. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden

    U Risérus & O Melander

  4. Department of Clinical Sciences, Lund University, Malmö, Sweden

    G Engström

  5. Department of Public Health and Caring Sciences/Section of Geriatrics, Uppsala University, Uppsala, Sweden

    J Ärnlöv

  6. School of Health and Social Studies, Dalarna University, Falun, Sweden

    J Ärnlöv

  7. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

    M-L Hellénius

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  1. A C Carlsson
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Correspondence to A C Carlsson.

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Carlsson, A., Risérus, U., Engström, G. et al. Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study. Int J Obes 37, 1579–1585 (2013). https://doi.org/10.1038/ijo.2013.46

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