Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies

David Wormser; Stephen Kaptoge; Emanuele Di Angelantonio; A. M. Wood; Lisa Pennells; A. Thompson; Nadeem Sarwar; Jorge R. Kizer; Debbie A. Lawlor; Børge G. Nordestgaard; Paul Ridker; Veikko Salomaa; June Stevens; Mark Woodward; Naveed Sattar; Rory Collins; Simon G. Thompson; Gary Whitlock; John Danesh; A. R. Folsom; L. E. Chambless; D. B. Panagiotakos; C. Pitsavos; C. Chrysohoou; C. Stefanadis; R. Atkins; E. L.M. Barr; J. E. Shaw; P. Z. Zimmet; P. H. Whincup; S. G. Wannamethee; R. W. Morris; S. Kiechl; J. Willeit; F. Oberhollenzer; A. Mayr; S. Ebrahim; J. Yarnell; J. Gallacher; P. J. Nietert; S. E. Sutherland; D. L. Bachman; J. E. Keil; K. J. Mukamal; I. H. De Boer; A. Tybjærg-Hansen; R. Frikke-Schmidt; S. Giampaoli; L. Palmieri; S. Panico; D. Vanuzzo; L. Pilotto; A. Gómez De La Cámara; M. A. Rubio; D. G. Blazer; J. M. Guralnik; C. L. Phillips; K. T. Khaw; K. Harald; P. Jousilahti; E. Vartiainen; R. B. D’Agostino; R. S. Vasan; C. S. Fox; M. J. Pencina; H. R. Dankner; A. Chetrit; F. Lubin; L. Wilhelmsen; H. Eriksson; K. Svärdsudd; L. Welin; A. Rosengren; G. Lappas; C. Björkelund; L. Lissner; C. Bengtsson; T. E. Strandberg; R. S. Tilvis; T. A. Miettinen; Y. Kiyohara; H. Arima; Y. Doi; T. Ninomiya; J. M. Dekker; G. Nijpels; C. D.A. Stehouwer; E. B. Rimm; J. K. Pai; H. Iso; A. Kitamura; K. Yamagishi; H. Noda; D. Deeg; J. L. Poppelaars; B. M. Psaty; S. Shea; A. Döring; W. Koenig; C. Meisinger; W. M.M. Verschuren; A. Blokstra; H. B. Bueno-De-Mesquita; A. Fletcher; R. F. Gillum; M. Mussolino; S. E. Hankinson; J. E. Manson; K. W. Davidson; S. Kirkland; J. A. Shaffer; M. R. Korin; S. Sato; S. J.L. Bakker; R. T. Gansevoort; H. L. Hillege; P. Amouyel; D. Arveiler; A. Evans; J. Ferrières; E. Barrett-Connor; D. L. Wingard; R. Bettencourt; J. Witteman; I. Kardys; H. Tiemeier; A. Hofman; H. Tunstall-Pedoe; R. Tavendale; G. D.O. Lowe; B. V. Howard; Y. Zhang; L. Best; J. Umans; A. Onat; G. Hergenç; G. Can; H. Nakagawa; M. Sakurai; K. Nakamura; Y. Morikawa; I. Njølstad; E. B. Mathiesen; M. L. Løchen; T. Wilsgaard; J. ørnlöv; J. Sundström; U. Risérus; E. Ingelsson; S. Wassertheil-Smoller; J. E. Manson; E. Brunner; M. Shipley; J. Buring; M. Walker; S. Watson; M. Alexander; A. S. Butterworth; O. H. Franco; P. Gao; R. Gobin; P. Haycock; S. R. Kondapally Seshasai; S. Lewington; I. R. White

doi:10.1016/S0140-6736(11)60105-0

Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies

David Wormser, Stephen Kaptoge, Emanuele Di Angelantonio, A. M. Wood, Lisa Pennells, A. Thompson, Nadeem Sarwar, Jorge R. Kizer, Debbie A. Lawlor, Børge G. Nordestgaard, Paul Ridker, Veikko Salomaa, June Stevens, Mark Woodward, Naveed Sattar, Rory Collins, Simon G. Thompson, Gary Whitlock, John Danesh, A. R. FolsomL. E. Chambless, D. B. Panagiotakos, C. Pitsavos, C. Chrysohoou, C. Stefanadis, R. Atkins, E. L.M. Barr, J. E. Shaw, P. Z. Zimmet, P. H. Whincup, S. G. Wannamethee, R. W. Morris, S. Kiechl, J. Willeit, F. Oberhollenzer, A. Mayr, S. Ebrahim, J. Yarnell, J. Gallacher, P. J. Nietert, S. E. Sutherland, D. L. Bachman, J. E. Keil, K. J. Mukamal, I. H. De Boer, A. Tybjærg-Hansen, R. Frikke-Schmidt, S. Giampaoli, L. Palmieri, S. Panico, D. Vanuzzo, L. Pilotto, A. Gómez De La Cámara, M. A. Rubio, D. G. Blazer, J. M. Guralnik, C. L. Phillips, K. T. Khaw, K. Harald, P. Jousilahti, E. Vartiainen, R. B. D’Agostino, R. S. Vasan, C. S. Fox, M. J. Pencina, H. R. Dankner, A. Chetrit, F. Lubin, L. Wilhelmsen, H. Eriksson, K. Svärdsudd, L. Welin, A. Rosengren, G. Lappas, C. Björkelund, L. Lissner, C. Bengtsson, T. E. Strandberg, R. S. Tilvis, T. A. Miettinen, Y. Kiyohara, H. Arima, Y. Doi, T. Ninomiya, J. M. Dekker, G. Nijpels, C. D.A. Stehouwer, E. B. Rimm, J. K. Pai, H. Iso, A. Kitamura, K. Yamagishi, H. Noda, D. Deeg, J. L. Poppelaars, B. M. Psaty, S. Shea, A. Döring, W. Koenig, C. Meisinger, W. M.M. Verschuren, A. Blokstra, H. B. Bueno-De-Mesquita, A. Fletcher, R. F. Gillum, M. Mussolino, S. E. Hankinson, J. E. Manson, K. W. Davidson, S. Kirkland, J. A. Shaffer, M. R. Korin, S. Sato, S. J.L. Bakker, R. T. Gansevoort, H. L. Hillege, P. Amouyel, D. Arveiler, A. Evans, J. Ferrières, E. Barrett-Connor, D. L. Wingard, R. Bettencourt, J. Witteman, I. Kardys, H. Tiemeier, A. Hofman, H. Tunstall-Pedoe, R. Tavendale, G. D.O. Lowe, B. V. Howard, Y. Zhang, L. Best, J. Umans, A. Onat, G. Hergenç, G. Can, H. Nakagawa, M. Sakurai, K. Nakamura, Y. Morikawa, I. Njølstad, E. B. Mathiesen, M. L. Løchen, T. Wilsgaard, J. ørnlöv, J. Sundström, U. Risérus, E. Ingelsson, S. Wassertheil-Smoller, J. E. Manson, E. Brunner, M. Shipley, J. Buring, M. Walker, S. Watson, M. Alexander, A. S. Butterworth, O. H. Franco, P. Gao, R. Gobin, P. Haycock, S. R. Kondapally Seshasai, S. Lewington, I. R. White

Research output: Contribution to journal › Article › peer-review

881 Scopus citations

Abstract

Background Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease. Methods We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4·56 kg/m² higher BMI, 12·6 cm higher waist circumference, and 0·083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios. Results Individual records were available for 221 934 people in 17 countries (14 297 incident cardiovascular disease outcomes; 1·87 million person-years at risk). Serial adiposity assessments were made in up to 63 821 people (mean interval 5·7 years [SD 3·9]). In people with BMI of 20 kg/m² or higher, HRs for cardiovascular disease were 1·23 (95% CI 1·17-1·29) with BMI, 1·27 (1·20-1·33) with waist circumference, and 1·25 (1·19-1·31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1·07 (1·03-1·11) with BMI, 1·10 (1·05-1·14) with waist circumference, and 1·12 (1·08-1·15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of-0·0001,-0·0001, and 0·0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement-0·19%,-0·05%, and-0·05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0·95, 95% CI 0·93-0·97) than for waist circumference (0·86, 0·83-0·89) or waist-to-hip ratio (0·63, 0·57-0·70). Interpretation BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

Original language	English (US)
Pages (from-to)	1085-1095
Number of pages	11
Journal	The Lancet
Volume	377
Issue number	9771
DOIs	https://doi.org/10.1016/S0140-6736(11)60105-0
State	Published - 2011
Externally published	Yes

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/S0140-6736(11)60105-0

Cite this

Wormser, D., Kaptoge, S., Di Angelantonio, E., Wood, A. M., Pennells, L., Thompson, A., Sarwar, N., Kizer, J. R., Lawlor, D. A., Nordestgaard, B. G., Ridker, P., Salomaa, V., Stevens, J., Woodward, M., Sattar, N., Collins, R., Thompson, S. G., Whitlock, G., Danesh, J., ... White, I. R. (2011). Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies. The Lancet, 377(9771), 1085-1095. https://doi.org/10.1016/S0140-6736(11)60105-0

Wormser, D, Kaptoge, S, Di Angelantonio, E, Wood, AM, Pennells, L, Thompson, A, Sarwar, N, Kizer, JR, Lawlor, DA, Nordestgaard, BG, Ridker, P, Salomaa, V, Stevens, J, Woodward, M, Sattar, N, Collins, R, Thompson, SG, Whitlock, G, Danesh, J, Folsom, AR, Chambless, LE, Panagiotakos, DB, Pitsavos, C, Chrysohoou, C, Stefanadis, C, Atkins, R, Barr, ELM, Shaw, JE, Zimmet, PZ, Whincup, PH, Wannamethee, SG, Morris, RW, Kiechl, S, Willeit, J, Oberhollenzer, F, Mayr, A, Ebrahim, S, Yarnell, J, Gallacher, J, Nietert, PJ, Sutherland, SE, Bachman, DL, Keil, JE, Mukamal, KJ, De Boer, IH, Tybjærg-Hansen, A, Frikke-Schmidt, R, Giampaoli, S, Palmieri, L, Panico, S, Vanuzzo, D, Pilotto, L, De La Cámara, AG, Rubio, MA, Blazer, DG, Guralnik, JM, Phillips, CL, Khaw, KT, Harald, K, Jousilahti, P, Vartiainen, E, D’Agostino, RB, Vasan, RS, Fox, CS, Pencina, MJ, Dankner, HR, Chetrit, A, Lubin, F, Wilhelmsen, L, Eriksson, H, Svärdsudd, K, Welin, L, Rosengren, A, Lappas, G, Björkelund, C, Lissner, L, Bengtsson, C, Strandberg, TE, Tilvis, RS, Miettinen, TA, Kiyohara, Y, Arima, H, Doi, Y, Ninomiya, T, Dekker, JM, Nijpels, G, Stehouwer, CDA, Rimm, EB, Pai, JK, Iso, H, Kitamura, A, Yamagishi, K, Noda, H, Deeg, D, Poppelaars, JL, Psaty, BM, Shea, S, Döring, A, Koenig, W, Meisinger, C, Verschuren, WMM, Blokstra, A, Bueno-De-Mesquita, HB, Fletcher, A, Gillum, RF, Mussolino, M, Hankinson, SE, Manson, JE, Davidson, KW, Kirkland, S, Shaffer, JA, Korin, MR, Sato, S, Bakker, SJL, Gansevoort, RT, Hillege, HL, Amouyel, P, Arveiler, D, Evans, A, Ferrières, J, Barrett-Connor, E, Wingard, DL, Bettencourt, R, Witteman, J, Kardys, I, Tiemeier, H, Hofman, A, Tunstall-Pedoe, H, Tavendale, R, Lowe, GDO, Howard, BV, Zhang, Y, Best, L, Umans, J, Onat, A, Hergenç, G, Can, G, Nakagawa, H, Sakurai, M, Nakamura, K, Morikawa, Y, Njølstad, I, Mathiesen, EB, Løchen, ML, Wilsgaard, T, ørnlöv, J, Sundström, J, Risérus, U, Ingelsson, E, Wassertheil-Smoller, S, Manson, JE, Brunner, E, Shipley, M, Buring, J, Walker, M, Watson, S, Alexander, M, Butterworth, AS, Franco, OH, Gao, P, Gobin, R, Haycock, P, Kondapally Seshasai, SR, Lewington, S & White, IR 2011, 'Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies', The Lancet, vol. 377, no. 9771, pp. 1085-1095. https://doi.org/10.1016/S0140-6736(11)60105-0

@article{7e92404ca7d5464b9fb6762bcef4bac7,

title = "Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies",

abstract = "Background Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease. Methods We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4·56 kg/m² higher BMI, 12·6 cm higher waist circumference, and 0·083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios. Results Individual records were available for 221 934 people in 17 countries (14 297 incident cardiovascular disease outcomes; 1·87 million person-years at risk). Serial adiposity assessments were made in up to 63 821 people (mean interval 5·7 years [SD 3·9]). In people with BMI of 20 kg/m² or higher, HRs for cardiovascular disease were 1·23 (95% CI 1·17-1·29) with BMI, 1·27 (1·20-1·33) with waist circumference, and 1·25 (1·19-1·31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1·07 (1·03-1·11) with BMI, 1·10 (1·05-1·14) with waist circumference, and 1·12 (1·08-1·15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of-0·0001,-0·0001, and 0·0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement-0·19%,-0·05%, and-0·05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0·95, 95% CI 0·93-0·97) than for waist circumference (0·86, 0·83-0·89) or waist-to-hip ratio (0·63, 0·57-0·70). Interpretation BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.",

author = "David Wormser and Stephen Kaptoge and {Di Angelantonio}, Emanuele and Wood, {A. M.} and Lisa Pennells and A. Thompson and Nadeem Sarwar and Kizer, {Jorge R.} and Lawlor, {Debbie A.} and Nordestgaard, {B{\o}rge G.} and Paul Ridker and Veikko Salomaa and June Stevens and Mark Woodward and Naveed Sattar and Rory Collins and Thompson, {Simon G.} and Gary Whitlock and John Danesh and Folsom, {A. R.} and Chambless, {L. E.} and Panagiotakos, {D. B.} and C. Pitsavos and C. Chrysohoou and C. Stefanadis and R. Atkins and Barr, {E. L.M.} and Shaw, {J. E.} and Zimmet, {P. Z.} and Whincup, {P. H.} and Wannamethee, {S. G.} and Morris, {R. W.} and S. Kiechl and J. Willeit and F. Oberhollenzer and A. Mayr and S. Ebrahim and J. Yarnell and J. Gallacher and Nietert, {P. J.} and Sutherland, {S. E.} and Bachman, {D. L.} and Keil, {J. E.} and Mukamal, {K. J.} and {De Boer}, {I. H.} and A. Tybj{\ae}rg-Hansen and R. Frikke-Schmidt and S. Giampaoli and L. Palmieri and S. Panico and D. Vanuzzo and L. Pilotto and {De La C{\'a}mara}, {A. G{\'o}mez} and Rubio, {M. A.} and Blazer, {D. G.} and Guralnik, {J. M.} and Phillips, {C. L.} and Khaw, {K. T.} and K. Harald and P. Jousilahti and E. Vartiainen and D{\textquoteright}Agostino, {R. B.} and Vasan, {R. S.} and Fox, {C. S.} and Pencina, {M. J.} and Dankner, {H. R.} and A. Chetrit and F. Lubin and L. Wilhelmsen and H. Eriksson and K. Sv{\"a}rdsudd and L. Welin and A. Rosengren and G. Lappas and C. Bj{\"o}rkelund and L. Lissner and C. Bengtsson and Strandberg, {T. E.} and Tilvis, {R. S.} and Miettinen, {T. A.} and Y. Kiyohara and H. Arima and Y. Doi and T. Ninomiya and Dekker, {J. M.} and G. Nijpels and Stehouwer, {C. D.A.} and Rimm, {E. B.} and Pai, {J. K.} and H. Iso and A. Kitamura and K. Yamagishi and H. Noda and D. Deeg and Poppelaars, {J. L.} and Psaty, {B. M.} and S. Shea and A. D{\"o}ring and W. Koenig and C. Meisinger and Verschuren, {W. M.M.} and A. Blokstra and Bueno-De-Mesquita, {H. B.} and A. Fletcher and Gillum, {R. F.} and M. Mussolino and Hankinson, {S. E.} and Manson, {J. E.} and Davidson, {K. W.} and S. Kirkland and Shaffer, {J. A.} and Korin, {M. R.} and S. Sato and Bakker, {S. J.L.} and Gansevoort, {R. T.} and Hillege, {H. L.} and P. Amouyel and D. Arveiler and A. Evans and J. Ferri{\`e}res and E. Barrett-Connor and Wingard, {D. L.} and R. Bettencourt and J. Witteman and I. Kardys and H. Tiemeier and A. Hofman and H. Tunstall-Pedoe and R. Tavendale and Lowe, {G. D.O.} and Howard, {B. V.} and Y. Zhang and L. Best and J. Umans and A. Onat and G. Hergen{\c c} and G. Can and H. Nakagawa and M. Sakurai and K. Nakamura and Y. Morikawa and I. Nj{\o}lstad and Mathiesen, {E. B.} and L{\o}chen, {M. L.} and T. Wilsgaard and J. {\o}rnl{\"o}v and J. Sundstr{\"o}m and U. Ris{\'e}rus and E. Ingelsson and S. Wassertheil-Smoller and Manson, {J. E.} and E. Brunner and M. Shipley and J. Buring and M. Walker and S. Watson and M. Alexander and Butterworth, {A. S.} and Franco, {O. H.} and P. Gao and R. Gobin and P. Haycock and {Kondapally Seshasai}, {S. R.} and S. Lewington and White, {I. R.}",

year = "2011",

doi = "10.1016/S0140-6736(11)60105-0",

language = "English (US)",

volume = "377",

pages = "1085--1095",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier Limited",

number = "9771",

}

TY - JOUR

T1 - Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease

T2 - Collaborative analysis of 58 prospective studies

AU - Wormser, David

AU - Kaptoge, Stephen

AU - Di Angelantonio, Emanuele

AU - Wood, A. M.

AU - Pennells, Lisa

AU - Thompson, A.

AU - Sarwar, Nadeem

AU - Kizer, Jorge R.

AU - Lawlor, Debbie A.

AU - Nordestgaard, Børge G.

AU - Ridker, Paul

AU - Salomaa, Veikko

AU - Stevens, June

AU - Woodward, Mark

AU - Sattar, Naveed

AU - Collins, Rory

AU - Thompson, Simon G.

AU - Whitlock, Gary

AU - Danesh, John

AU - Folsom, A. R.

AU - Chambless, L. E.

AU - Panagiotakos, D. B.

AU - Pitsavos, C.

AU - Chrysohoou, C.

AU - Stefanadis, C.

AU - Atkins, R.

AU - Barr, E. L.M.

AU - Shaw, J. E.

AU - Zimmet, P. Z.

AU - Whincup, P. H.

AU - Wannamethee, S. G.

AU - Morris, R. W.

AU - Kiechl, S.

AU - Willeit, J.

AU - Oberhollenzer, F.

AU - Mayr, A.

AU - Ebrahim, S.

AU - Yarnell, J.

AU - Gallacher, J.

AU - Nietert, P. J.

AU - Sutherland, S. E.

AU - Bachman, D. L.

AU - Keil, J. E.

AU - Mukamal, K. J.

AU - De Boer, I. H.

AU - Tybjærg-Hansen, A.

AU - Frikke-Schmidt, R.

AU - Giampaoli, S.

AU - Palmieri, L.

AU - Panico, S.

AU - Vanuzzo, D.

AU - Pilotto, L.

AU - De La Cámara, A. Gómez

AU - Rubio, M. A.

AU - Blazer, D. G.

AU - Guralnik, J. M.

AU - Phillips, C. L.

AU - Khaw, K. T.

AU - Harald, K.

AU - Jousilahti, P.

AU - Vartiainen, E.

AU - D’Agostino, R. B.

AU - Vasan, R. S.

AU - Fox, C. S.

AU - Pencina, M. J.

AU - Dankner, H. R.

AU - Chetrit, A.

AU - Lubin, F.

AU - Wilhelmsen, L.

AU - Eriksson, H.

AU - Svärdsudd, K.

AU - Welin, L.

AU - Rosengren, A.

AU - Lappas, G.

AU - Björkelund, C.

AU - Lissner, L.

AU - Bengtsson, C.

AU - Strandberg, T. E.

AU - Tilvis, R. S.

AU - Miettinen, T. A.

AU - Kiyohara, Y.

AU - Arima, H.

AU - Doi, Y.

AU - Ninomiya, T.

AU - Dekker, J. M.

AU - Nijpels, G.

AU - Stehouwer, C. D.A.

AU - Rimm, E. B.

AU - Pai, J. K.

AU - Iso, H.

AU - Kitamura, A.

AU - Yamagishi, K.

AU - Noda, H.

AU - Deeg, D.

AU - Poppelaars, J. L.

AU - Psaty, B. M.

AU - Shea, S.

AU - Döring, A.

AU - Koenig, W.

AU - Meisinger, C.

AU - Verschuren, W. M.M.

AU - Blokstra, A.

AU - Bueno-De-Mesquita, H. B.

AU - Fletcher, A.

AU - Gillum, R. F.

AU - Mussolino, M.

AU - Hankinson, S. E.

AU - Manson, J. E.

AU - Davidson, K. W.

AU - Kirkland, S.

AU - Shaffer, J. A.

AU - Korin, M. R.

AU - Sato, S.

AU - Bakker, S. J.L.

AU - Gansevoort, R. T.

AU - Hillege, H. L.

AU - Amouyel, P.

AU - Arveiler, D.

AU - Evans, A.

AU - Ferrières, J.

AU - Barrett-Connor, E.

AU - Wingard, D. L.

AU - Bettencourt, R.

AU - Witteman, J.

AU - Kardys, I.

AU - Tiemeier, H.

AU - Hofman, A.

AU - Tunstall-Pedoe, H.

AU - Tavendale, R.

AU - Lowe, G. D.O.

AU - Howard, B. V.

AU - Zhang, Y.

AU - Best, L.

AU - Umans, J.

AU - Onat, A.

AU - Hergenç, G.

AU - Can, G.

AU - Nakagawa, H.

AU - Sakurai, M.

AU - Nakamura, K.

AU - Morikawa, Y.

AU - Njølstad, I.

AU - Mathiesen, E. B.

AU - Løchen, M. L.

AU - Wilsgaard, T.

AU - ørnlöv, J.

AU - Sundström, J.

AU - Risérus, U.

AU - Ingelsson, E.

AU - Wassertheil-Smoller, S.

AU - Manson, J. E.

AU - Brunner, E.

AU - Shipley, M.

AU - Buring, J.

AU - Walker, M.

AU - Watson, S.

AU - Alexander, M.

AU - Butterworth, A. S.

AU - Franco, O. H.

AU - Gao, P.

AU - Gobin, R.

AU - Haycock, P.

AU - Kondapally Seshasai, S. R.

AU - Lewington, S.

AU - White, I. R.

PY - 2011

Y1 - 2011

N2 - Background Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease. Methods We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4·56 kg/m² higher BMI, 12·6 cm higher waist circumference, and 0·083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios. Results Individual records were available for 221 934 people in 17 countries (14 297 incident cardiovascular disease outcomes; 1·87 million person-years at risk). Serial adiposity assessments were made in up to 63 821 people (mean interval 5·7 years [SD 3·9]). In people with BMI of 20 kg/m² or higher, HRs for cardiovascular disease were 1·23 (95% CI 1·17-1·29) with BMI, 1·27 (1·20-1·33) with waist circumference, and 1·25 (1·19-1·31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1·07 (1·03-1·11) with BMI, 1·10 (1·05-1·14) with waist circumference, and 1·12 (1·08-1·15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of-0·0001,-0·0001, and 0·0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement-0·19%,-0·05%, and-0·05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0·95, 95% CI 0·93-0·97) than for waist circumference (0·86, 0·83-0·89) or waist-to-hip ratio (0·63, 0·57-0·70). Interpretation BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

AB - Background Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease. Methods We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4·56 kg/m² higher BMI, 12·6 cm higher waist circumference, and 0·083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios. Results Individual records were available for 221 934 people in 17 countries (14 297 incident cardiovascular disease outcomes; 1·87 million person-years at risk). Serial adiposity assessments were made in up to 63 821 people (mean interval 5·7 years [SD 3·9]). In people with BMI of 20 kg/m² or higher, HRs for cardiovascular disease were 1·23 (95% CI 1·17-1·29) with BMI, 1·27 (1·20-1·33) with waist circumference, and 1·25 (1·19-1·31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1·07 (1·03-1·11) with BMI, 1·10 (1·05-1·14) with waist circumference, and 1·12 (1·08-1·15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of-0·0001,-0·0001, and 0·0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement-0·19%,-0·05%, and-0·05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0·95, 95% CI 0·93-0·97) than for waist circumference (0·86, 0·83-0·89) or waist-to-hip ratio (0·63, 0·57-0·70). Interpretation BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

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U2 - 10.1016/S0140-6736(11)60105-0

DO - 10.1016/S0140-6736(11)60105-0

M3 - Article

C2 - 21397319

AN - SCOPUS:79953163759

SN - 0140-6736

VL - 377

SP - 1085

EP - 1095

JO - The Lancet

JF - The Lancet

IS - 9771

ER -

Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies

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UN SDGs

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