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 - http://www.scopus.com/inward/record.url?scp=77951626838&partnerID=8YFLogxK
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 -