1] Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden [2] Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Int J Obes (Lond). 2013 Dec;37(12):1579-85. doi: 10.1038/ijo.2013.46. Epub 2013 Mar 28.
The aim of this study was to compare novel and established anthropometrical measures in their ability to predict cardiovascular disease (CVD), and to determine whether they improve risk prediction beyond classical risk factors in a cohort study of 60-year-old men and women. We also stratified the results according to gender to identify possible differences between men and women. Furthermore, we aimed to replicate our findings in a large independent cohort (The Malmö Diet and Cancer study-cardiovascular cohort).
This was a population-based study of 1751 men and 1990 women, aged 60 years and without CVD at baseline, with 375 incident cases of CVD during 11 years of follow-up. Weight, height, waist circumference (WC), hip circumference and sagittal abdominal diameter (SAD) were measured at baseline. Body mass index (BMI), waist-hip ratio (WHR), waist-hip-height ratio (WHHR), WC-to-height ratio (WCHR) and SAD-to-height ratio (SADHR) were calculated.
All anthropometric measures predicted CVD in unadjusted Cox regression models per s.d. increment (hazard ratios, 95% confidence interval), while significant associations after adjustments for established risk CVD factors were noted for WHHR 1.20 (1.08-1.33), WHR 1.14 (1.02-1.28), SAD 1.13 (1.02-1.25) and SADHR 1.17 (1.06-1.28). WHHR had higher increases in C-statistics, and model improvements (likelihood ratio tests (P<0.001)). In the replication study (MDC-CC, n=5180), WHHR was the only measure that improved Cox regression models in men (P=0.01).
WHHR, a new measure reflecting body fat distribution, showed the highest risk estimates after adjustments for established CVD risk factors. These findings were verified in men but not women in an independent cohort.
本研究旨在比较新的和已建立的人体测量学指标在预测心血管疾病（CVD）方面的能力，并确定它们是否能在一项 60 岁男性和女性队列研究中，在经典危险因素之外改善风险预测。我们还按性别对结果进行分层，以确定男女之间可能存在的差异。此外，我们旨在在一个大型独立队列（马尔默饮食与癌症研究 - 心血管队列）中复制我们的发现。
这是一项基于人群的研究，纳入了 1751 名男性和 1990 名女性，年龄 60 岁，基线时无 CVD，随访 11 年期间有 375 例 CVD 事件。在基线时测量体重、身高、腰围（WC）、臀围和矢状腹部直径（SAD）。计算体重指数（BMI）、腰臀比（WHR）、腰臀高比（WHHR）、WC 与身高比（WCHR）和 SAD 与身高比（SADHR）。
在未经调整的 Cox 回归模型中，所有人体测量指标每增加一个标准差（风险比，95%置信区间）都预测 CVD，而在调整了已建立的 CVD 风险因素后，WHHR 为 1.20（1.08-1.33）、WHR 为 1.14（1.02-1.28）、SAD 为 1.13（1.02-1.25）和 SADHR 为 1.17（1.06-1.28）仍有显著关联。WHHR 增加了 C 统计量和模型改善（似然比检验（P<0.001））。在复制研究（MDC-CC，n=5180）中，WHHR 是唯一改善男性 Cox 回归模型的指标（P=0.01）。
WHHR，一种反映体脂分布的新指标，在调整了已建立的 CVD 风险因素后，显示出最高的风险估计。这些发现在一个独立的队列中得到了验证，但在女性中没有得到验证。
