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

• Published in: Preventive medicine reports Vol. 26; p. 101700
• Main Authors: Rosberg, Victoria, Vishram-Nielsen, Julie KK, Kristensen, Anna M. Dyrvig, Pareek, Manan, Sehested, Thomas S.G., Nilsson, Peter M, Linneberg, Allan, Palmieri, Luigi, Giampaoli, Simona, Donfrancesco, Chiara, Kee, Frank, Mancia, Giuseppe, Cesana, Giancarlo, Veronesi, Giovanni, Grassi, Guido, Kuulasmaa, Kari, Salomaa, Veikko, Palosaari, Tarja, Sans, Susana, Ferrieres, Jean, Dallongeville, Jean, Söderberg, Stefan, Moitry, Marie, Drygas, Wojciech, Tamosiunas, Abdonas, Peters, Annette, Brenner, Hermann, Schöttker, Ben, Grimsgaard, Sameline, Biering-Sørensen, Tor, Olsen, Michael H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2022; Elsevier
• Subjects: Adipose tissue; Assessment; Assessment, risk; Body mass index; Cancer and Oncology; Cancer och onkologi; Cardiac and Cardiovascular Systems; Cardiology and Cardiovascular Disease; Cardiovascular diseases; Cholesterol; Clinical Medicine; Internal Medicine; Kardiologi; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Life Sciences; Medical and Health Sciences; Medicin och hälsovetenskap; Regular; risk; Santé publique et épidémiologie; Waist-hip ratio; PP; Chol; SCORE; Adipose tissue; NRI; ASCVD; NS; HDL-cholesterol; HR; EFM; BP; AUCROC; Body mass index; DBP; MACE; MONICA; MBP; BMI; SBP; WHR; CI; MORGAM; ACM; IQR; cNRI; Waist-hip ratio; Cholesterol; CEP; CVD; CV; Assessment, risk; CVM; Cardiovascular diseases; composite cardiovascular endpoint; systolic blood pressure; diastolic blood pressure; cholesterol; major adverse cardiovascular events; assessment, risk; blood pressure; non-significant; estimated fat mass; waist-hip ratio; body mass index; net reclassification improvement; serum total cholesterol; high density lipoprotein cholesterol; all-cause mortality; atherosclerotic cardiovascular disease; interquartile range; AUC ROC; continuous net reclassification improvement; cardiovascular disease; pulse pressure; area under the receiver-operating-characteristic curve; cardiovascular mortality; cardiovascular diseases; cardiovascular; Systematic COronary Risk Evaluation; MOnica, Risk, Genetics, Archiving and Monograph; hazard ratio; confidence interval; mean blood pressure; Multi-national MONItoring of Trends and Determinants in CArdiovascular Disease; CI, confidence interval; MACE, major adverse cardiovascular events; CVD, cardiovascular disease; DBP, diastolic blood pressure; HDL-cholesterol, high density lipoprotein cholesterol; SBP, systolic blood pressure; BMI, body mass index; NRI, net reclassification improvement; ACM, all-cause mortality; EFM, estimated fat mass; BP, blood pressure; PP, pulse pressure; WHR, waist-hip ratio; MBP, mean blood pressure; CVM, cardiovascular mortality; AUCROC, area under the receiver-operating-characteristic curve; HR, hazard ratio; MORGAM, MOnica, Risk, Genetics, Archiving and Monograph; MONICA, Multi-national MONItoring of Trends and Determinants in CArdiovascular Disease; IQR, interquartile range; SCORE, Systematic COronary Risk Evaluation; NS, non-significant; CV, cardiovascular; ASCVD, atherosclerotic cardiovascular disease; Chol, serum total cholesterol; CEP, composite cardiovascular endpoint; cNRI, continuous net reclassification improvement; Genetics; Assessment; Risk; Archiving and Monograph
• ISSN: 2211-3355; 2211-3355
• DOI: 10.1016/j.pmedr.2022.101700

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.