Medizinische Klinik-Innenstadt, Ludwig-Maximilians University, Ziemssenstrasse 1, 80336 Munich, Germany.
J Clin Endocrinol Metab. 2010 Apr;95(4):1777-85. doi: 10.1210/jc.2009-1584. Epub 2010 Feb 3.
To date, it is unclear which measure of obesity is the most appropriate for risk stratification.
The aim of the study was to compare the associations of various measures of obesity with incident cardiovascular events and mortality.
We analyzed two German cohort studies, the DETECT study and SHIP, including primary care and general population.
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.
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.
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.
WHtR represents the best predictor of cardiovascular risk and mortality, followed by WC and WHR. Our results discourage the use of the BMI.
目前，尚不清楚哪种肥胖测量方法最适合风险分层。
本研究旨在比较各种肥胖测量方法与心血管事件和死亡率发生的相关性。
我们分析了两项德国队列研究，即 DETECT 研究和 SHIP，包括初级保健和一般人群。
共有 6355 名（平均随访 3.3 年）和 4297 名（平均随访 8.5 年）个体分别参加了 DETECT 和 SHIP 研究。
我们测量了体重指数（BMI）、腰围（WC）、腰高比（WHtR）和腰臀比（WHR），并评估了心血管和全因死亡率以及中风、心肌梗死或心血管死亡的复合终点。
在两项研究中，我们发现复合终点与 WHtR 呈正相关，而与 BMI 无关。研究之间没有异质性。在调整了多种混杂因素后，WHtR 最高与最低性别和年龄四分位组之间的相对风险如下：心血管死亡率为 2.75（95%置信区间，1.31-5.77）、1.74（0.84-3.6）、1.71（0.91-3.22）和 0.74（0.35-1.57）；全因死亡率为 1.86（1.25-2.76）、1.62（1.22-2.38）、1.36（0.93-1.69）和 0.77（0.53-1.13）；复合终点为 2.16（1.39-3.35）、1.59（1.04-2.44）、1.49（1.07-2.07）和 0.57（0.37-0.89）。对性别和年龄组的单独分析得出了类似的结果。受试者工作特征曲线分析显示，WHtR 对这些终点的预测具有最高的曲线下面积。
WHtR 是心血管风险和死亡率的最佳预测指标，其次是 WC 和 WHR。我们的结果不鼓励使用 BMI。
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