Emerging Risk Factors Collaboration Coordinating Centre, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Lancet. 2011 Mar 26;377(9771):1085-95. doi: 10.1016/S0140-6736(11)60105-0.
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.
We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4.56 kg/m(2) 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.
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/m(2) 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).
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.
British Heart Foundation and UK Medical Research Council.
当有其他风险因素的信息时，指南对评估肥胖指标在心血管疾病风险预测中的价值存在差异。我们研究了体重指数（BMI）、腰围和腰臀比与首发心血管疾病风险的单独和联合关联。
我们使用来自 58 个队列的个体记录，计算基线值每升高 1 SD 的风险比（HR）（BMI 升高 4.56kg/m2，腰围升高 12.6cm，腰臀比升高 0.083）和风险判别和重新分类的措施。连续的肥胖评估用于计算回归稀释比。
在 17 个国家，共有 221934 人（14297 例心血管疾病事件；187 万人年风险）提供了个体记录。多达 63821 人进行了连续的肥胖评估（平均间隔 5.7 年[SD 3.9]）。在 BMI 为 20kg/m2 或更高的人群中，BMI、腰围和腰臀比与心血管疾病的 HR 分别为 1.23（95%CI 1.17-1.29）、1.27（1.20-1.33）和 1.25（1.19-1.31），经年龄、性别和吸烟状况调整后。进一步调整基线收缩压、糖尿病史、总胆固醇和 HDL 胆固醇后，相应的 HR 分别为 1.07（1.03-1.11）、1.10（1.05-1.14）和 1.12（1.08-1.15）。在包含传统危险因素的心血管疾病风险预测模型中添加 BMI、腰围或腰臀比的信息并不会显著提高风险判别（C 指数的变化分别为-0.0001、-0.0001 和 0.0008），也不会提高对参与者进行预测 10 年风险类别的分类（净重新分类改善分别为-0.19%、-0.05%和-0.05%）。当综合考虑肥胖指标时，结果类似。BMI 的重现性优于腰围（0.95，95%CI 0.93-0.97）和腰臀比（0.63，0.57-0.70）。
在有收缩压、糖尿病史和血脂的额外信息时，BMI、腰围和腰臀比，无论是单独评估还是组合评估，在发达国家人群中对心血管疾病风险预测的改善并不显著。
英国心脏基金会和英国医学研究理事会。
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