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BMI, waist circumference, waist-to-hip ratio unreliable predictors of CVD risk

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BMI, waist circumference and waist-to-hip ratio are important indicators of obesity, but they do little to enhance prediction of cardiovascular disease, researchers said.

“National and international guidelines have provided differing recommendations about the value of clinical measures of adiposity for prediction of CVD risk in primary prevention,” according to researchers from the Emerging Risk Factors Collaboration.

To establish the role adiposity measures play in estimating risk for CVD, the researchers examined individual data from 221,934 participants (mean age, 58 years) in 58 prospective cohort studies. They subsequently calculated HRs for coronary artery disease, ischemic stroke, coronary heart disease and any cerebrovascular disease. Of all participants, 70% also had available data on smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol levels. Although participants resided in 17 countries throughout the world, most were in Europe (58%).

After adjustment for age, sex and smoking status, HRs for CVD in people with BMI of at least 20 were 1.23 (95% CI, 1.17-1.29) when calculated with BMI, 1.27 (95% CI, 1.2-1.33) with waist circumference and 1.25 (95% CI, 1.19-1.31) with waist-to-hip ratio, according to the results.

Data also show that after adjustment for systolic BP, history of diabetes, and total and HDL cholesterol, HRs for CVD were 1.07 (95% CI, 1.03-1.11) with BMI, 1.1 (95% CI, 1.05-1.14) with waist circumference and 1.12 (95% CI, 1.08-1.15) with waist-to-hip ratio.

None of the adiposity measures meaningfully improved risk discrimination or classification of participants to categories of predicted 10-year risk when added to a risk prediction model using conventional risk factors. Using the measures in combination also did not yield significantly different results, according to the researchers.

However, BMI had greater reproducibility when compared with waist circumference or waist-to-hip ratio.

The results led researchers to conclude that these adiposity measures contribute little to prediction of CV risk when information on BP, history of diabetes and lipids is available.

“Many overweight or obese adolescents, young adults and middle-aged individuals with few risk factors for CVD will develop that risk relatively soon, so BMI should serve as an early warning, both to them and their general practitioners,” Rachel R. Huxley, DPhil, and David R. Jacobs Jr., PhD, both of the University of Minnesota, wrote in an accompanying editorial. “But identification of which overweight individuals without risk factors for CVD will go on to develop these risk factors, and ultimately clinical CVD, remains a challenge — here, blood tests continue to be helpful.”

Disclosures: Several researchers report receiving various consulting fees, research grants, board membership and patent ownership from several companies. For a full list of disclosures, see the full study. Drs. Huxley and Jacobs report no relevant financial disclosures.

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