The predictive value of different measures of obesity for incident cardiovascular events and mortality

Harald J. Schneider; Nele Friedrich; Jens Klotsche; Lars Pieper; Matthias Nauck; Ulrich John; Marcus Dörr; Stephan Felix; Hendrik Lehnert; David Pittrow; Sigmund Silber; Henry Völzke; Günter K. Stalla; Henri Wallaschofski; Hans Ulrich Wittchen

doi:10.1210/jc.2009-1584

The predictive value of different measures of obesity for incident cardiovascular events and mortality

Harald J. Schneider, Nele Friedrich, Jens Klotsche, Lars Pieper, Matthias Nauck, Ulrich John, Marcus Dörr, Stephan Felix, Hendrik Lehnert, David Pittrow, Sigmund Silber, Henry Völzke, Günter K. Stalla, Henri Wallaschofski, Hans Ulrich Wittchen

Medizinische Klinik I

379 Zitate (Scopus)

Abstract

Context: To date, it is unclear which measure of obesity is the most appropriate for risk stratification. Objective: The aim of the study was to compare the associations of various measures of obesity with incident cardiovascular events and mortality. Design and Setting: We analyzed two German cohort studies, the DETECT study and SHIP, including primary care and general population. Participants: A total of 6355 (mean follow-up, 3.3 yr) and 4297 (mean follow-up, 8.5 yr) individuals participated in DETECT and SHIP, respectively. Interventions: We measured body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) and assessed cardiovascular and all-cause mortality and the composite endpoint of incident stroke, myocardial infarction, or cardiovascular death. Results: In both studies, we found a positive association of the composite endpoint with WHtR but not with BMI. There was no heterogeneity among studies. The relative risks in the highest versus the lowest sex- and age-specific quartile of WHtR, WC, WHR, and BMI after adjustment for multiple confounders were as follows in the pooled data: cardiovascular mortality, 2.75 (95% confidence interval, 1.31-5.77), 1.74 (0.84-3.6), 1.71 (0.91-3.22), and 0.74 (0.35-1.57), respectively; all-cause mortality, 1.86 (1.25-2.76), 1.62 (1.22-2.38), 1.36 (0.93-1.69), and 0.77 (0.53-1.13), respectively; and composite endpoint, 2.16 (1.39-3.35), 1.59 (1.04-2.44), 1.49 (1.07-2.07), and 0.57 (0.37-0.89), respectively. Separate analyses of sex and age groups yielded comparable results. Receiver operating characteristics analysis yielded the highest areas under the curve for WHtR for predicting these endpoints. Conclusions: WHtR represents the best predictor of cardiovascular risk and mortality, followed by WC and WHR. Our results discourage the use of the BMI.

Originalsprache	Englisch
Zeitschrift	Journal of Clinical Endocrinology and Metabolism
Jahrgang	95
Ausgabenummer	4
Seiten (von - bis)	1777-1785
Seitenumfang	9
ISSN	0021-972X
DOIs	https://doi.org/10.1210/jc.2009-1584
Publikationsstatus	Veröffentlicht - 01.01.2010

Fördermittel

DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment) is a cross-sectional and prospective-longitudinal, nationwide clinical epidemiological study. DETECT is supported by an unrestricted educational grant of Pfizer GmbH, Karlsruhe, Germany. Members of the DETECT study group include: Principal investigator: Professor Dr. H.-U. Wittchen; Staff members: Dipl.-Psych. L. Pieper, Dipl.-Math. J. Klotsche, Dr. T. Eichler, Dr. H. Glaesmer, E. Katze. Steering Committee: Professor Dr. H. Lehnert (Lübeck); Professor Dr. G. K. Stalla (München); Professor Dr. A. M. Zeiher (Frankfurt). Advisory Board: Professor Dr. W. März (Heidelberg/Graz); Professor Dr. S. Silber (München); Professor Dr. Dr. U. Koch (Hamburg); Priv.-Doz. Dr. D. Pittrow (München/Dresden); Professor Dr. M. Wehling (Mannheim); Dr. D. Leistner (Frankfurt); Dr. H. J. Schneider (München); Dr. C. Sievers (München). SHIP is part of the Community Medicine Research net (CMR) of the University of Greifswald, Greifswald, Germany, which is funded by the Federal Ministry of Education and Research, the Ministry of Cultural Affairs as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania. The CMR encompasses several research projects that share data from the population-based Study of Health in Pomerania (SHIP; http://ship.community-medicine.de ). Statistical analyses were supported by the Competence Network Diabetes of the German Federal Ministry of Education and Research.

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10.1210/jc.2009-1584

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Schneider, H. J., Friedrich, N., Klotsche, J., Pieper, L., Nauck, M., John, U., Dörr, M., Felix, S., Lehnert, H., Pittrow, D., Silber, S., Völzke, H., Stalla, G. K., Wallaschofski, H., & Wittchen, H. U. (2010). The predictive value of different measures of obesity for incident cardiovascular events and mortality. Journal of Clinical Endocrinology and Metabolism, 95(4), 1777-1785. https://doi.org/10.1210/jc.2009-1584

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title = "The predictive value of different measures of obesity for incident cardiovascular events and mortality",

abstract = "Context: To date, it is unclear which measure of obesity is the most appropriate for risk stratification. Objective: The aim of the study was to compare the associations of various measures of obesity with incident cardiovascular events and mortality. Design and Setting: We analyzed two German cohort studies, the DETECT study and SHIP, including primary care and general population. Participants: A total of 6355 (mean follow-up, 3.3 yr) and 4297 (mean follow-up, 8.5 yr) individuals participated in DETECT and SHIP, respectively. Interventions: We measured body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) and assessed cardiovascular and all-cause mortality and the composite endpoint of incident stroke, myocardial infarction, or cardiovascular death. Results: In both studies, we found a positive association of the composite endpoint with WHtR but not with BMI. There was no heterogeneity among studies. The relative risks in the highest versus the lowest sex- and age-specific quartile of WHtR, WC, WHR, and BMI after adjustment for multiple confounders were as follows in the pooled data: cardiovascular mortality, 2.75 (95\% confidence interval, 1.31-5.77), 1.74 (0.84-3.6), 1.71 (0.91-3.22), and 0.74 (0.35-1.57), respectively; all-cause mortality, 1.86 (1.25-2.76), 1.62 (1.22-2.38), 1.36 (0.93-1.69), and 0.77 (0.53-1.13), respectively; and composite endpoint, 2.16 (1.39-3.35), 1.59 (1.04-2.44), 1.49 (1.07-2.07), and 0.57 (0.37-0.89), respectively. Separate analyses of sex and age groups yielded comparable results. Receiver operating characteristics analysis yielded the highest areas under the curve for WHtR for predicting these endpoints. Conclusions: WHtR represents the best predictor of cardiovascular risk and mortality, followed by WC and WHR. Our results discourage the use of the BMI.",

author = "Schneider, \{Harald J.\} and Nele Friedrich and Jens Klotsche and Lars Pieper and Matthias Nauck and Ulrich John and Marcus D{\"o}rr and Stephan Felix and Hendrik Lehnert and David Pittrow and Sigmund Silber and Henry V{\"o}lzke and Stalla, \{G{\"u}nter K.\} and Henri Wallaschofski and Wittchen, \{Hans Ulrich\}",

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doi = "10.1210/jc.2009-1584",

language = "English",

volume = "95",

pages = "1777--1785",

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issn = "0021-972X",

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Schneider, HJ, Friedrich, N, Klotsche, J, Pieper, L, Nauck, M, John, U, Dörr, M, Felix, S, Lehnert, H, Pittrow, D, Silber, S, Völzke, H, Stalla, GK, Wallaschofski, H & Wittchen, HU 2010, 'The predictive value of different measures of obesity for incident cardiovascular events and mortality', Journal of Clinical Endocrinology and Metabolism, Jg. 95, Nr. 4, S. 1777-1785. https://doi.org/10.1210/jc.2009-1584

TY - JOUR

T1 - The predictive value of different measures of obesity for incident cardiovascular events and mortality

AU - Schneider, Harald J.

AU - Friedrich, Nele

AU - Klotsche, Jens

AU - Pieper, Lars

AU - Nauck, Matthias

AU - John, Ulrich

AU - Dörr, Marcus

AU - Felix, Stephan

AU - Lehnert, Hendrik

AU - Pittrow, David

AU - Silber, Sigmund

AU - Völzke, Henry

AU - Stalla, Günter K.

AU - Wallaschofski, Henri

AU - Wittchen, Hans Ulrich

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Context: To date, it is unclear which measure of obesity is the most appropriate for risk stratification. Objective: The aim of the study was to compare the associations of various measures of obesity with incident cardiovascular events and mortality. Design and Setting: We analyzed two German cohort studies, the DETECT study and SHIP, including primary care and general population. Participants: A total of 6355 (mean follow-up, 3.3 yr) and 4297 (mean follow-up, 8.5 yr) individuals participated in DETECT and SHIP, respectively. Interventions: We measured body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) and assessed cardiovascular and all-cause mortality and the composite endpoint of incident stroke, myocardial infarction, or cardiovascular death. Results: In both studies, we found a positive association of the composite endpoint with WHtR but not with BMI. There was no heterogeneity among studies. The relative risks in the highest versus the lowest sex- and age-specific quartile of WHtR, WC, WHR, and BMI after adjustment for multiple confounders were as follows in the pooled data: cardiovascular mortality, 2.75 (95% confidence interval, 1.31-5.77), 1.74 (0.84-3.6), 1.71 (0.91-3.22), and 0.74 (0.35-1.57), respectively; all-cause mortality, 1.86 (1.25-2.76), 1.62 (1.22-2.38), 1.36 (0.93-1.69), and 0.77 (0.53-1.13), respectively; and composite endpoint, 2.16 (1.39-3.35), 1.59 (1.04-2.44), 1.49 (1.07-2.07), and 0.57 (0.37-0.89), respectively. Separate analyses of sex and age groups yielded comparable results. Receiver operating characteristics analysis yielded the highest areas under the curve for WHtR for predicting these endpoints. Conclusions: WHtR represents the best predictor of cardiovascular risk and mortality, followed by WC and WHR. Our results discourage the use of the BMI.

AB - Context: To date, it is unclear which measure of obesity is the most appropriate for risk stratification. Objective: The aim of the study was to compare the associations of various measures of obesity with incident cardiovascular events and mortality. Design and Setting: We analyzed two German cohort studies, the DETECT study and SHIP, including primary care and general population. Participants: A total of 6355 (mean follow-up, 3.3 yr) and 4297 (mean follow-up, 8.5 yr) individuals participated in DETECT and SHIP, respectively. Interventions: We measured body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) and assessed cardiovascular and all-cause mortality and the composite endpoint of incident stroke, myocardial infarction, or cardiovascular death. Results: In both studies, we found a positive association of the composite endpoint with WHtR but not with BMI. There was no heterogeneity among studies. The relative risks in the highest versus the lowest sex- and age-specific quartile of WHtR, WC, WHR, and BMI after adjustment for multiple confounders were as follows in the pooled data: cardiovascular mortality, 2.75 (95% confidence interval, 1.31-5.77), 1.74 (0.84-3.6), 1.71 (0.91-3.22), and 0.74 (0.35-1.57), respectively; all-cause mortality, 1.86 (1.25-2.76), 1.62 (1.22-2.38), 1.36 (0.93-1.69), and 0.77 (0.53-1.13), respectively; and composite endpoint, 2.16 (1.39-3.35), 1.59 (1.04-2.44), 1.49 (1.07-2.07), and 0.57 (0.37-0.89), respectively. Separate analyses of sex and age groups yielded comparable results. Receiver operating characteristics analysis yielded the highest areas under the curve for WHtR for predicting these endpoints. Conclusions: WHtR represents the best predictor of cardiovascular risk and mortality, followed by WC and WHR. Our results discourage the use of the BMI.

UR - https://www.scopus.com/pages/publications/77951626838

U2 - 10.1210/jc.2009-1584

DO - 10.1210/jc.2009-1584

M3 - Journal articles

C2 - 20130075

AN - SCOPUS:77951626838

SN - 0021-972X

VL - 95

SP - 1777

EP - 1785

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 4

ER -

The predictive value of different measures of obesity for incident cardiovascular events and mortality

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