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

Victoria Rosberg, Julie KK Vishram-Nielsen*, Anna M Dyrvig Kristensen, Manan Pareek, Thomas S G Sehested, Peter M Nilsson, Allan Linneberg, Luigi Palmieri, Simona Giampaoli, Chiara Donfrancesco, Frank Kee, Giuseppe Mancia, Giancarlo Cesana, Giovanni Veronesi, Guido Grassi, Kari Kuulasmaa, Veikko Salomaa, Tarja Palosaari, Susana Sans, Jean FerrieresJean Dallongeville, Stefan Söderberg, Marie Moitry, Wojciech Drygas, Abdonas Tamosiunas, Annette Peters, Hermann Brenner, Ben Schöttker, Sameline Grimsgaard, Tor Biering-Sørensen, Michael H Olsen

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review


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.

TidsskriftPreventive Medicine Reports
StatusUdgivet - apr. 2022

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© 2022 The Author(s).


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