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Rosberg, V.* ; Vishram-Nielsen, J.K.K.* ; Kristensen, A.M.D.* ; Pareek, M.* ; Sehested, T.S.G.* ; Nilsson, P.M.* ; Linneberg, A.* ; Palmieri, L.* ; Giampaoli, S.* ; Donfrancesco, C.* ; Kee, F.* ; Mancia, G.* ; Cesana, G.* ; Veronesi, G.* ; Grassi, G.* ; Kuulasmaa, K.* ; Salomaa, V.* ; Palosaari, T.* ; Sans, S.* ; Ferrieres, J.* ; Dallongeville, J.* ; Söderberg, S.* ; Moitry, M.* ; Drygas, W.* ; Tamosiunas, A.* ; Peters, A. ; Brenner, H.* ; Schöttker, B.* ; Grimsgaard, S.* ; Biering-Sørensen, T.* ; Olsen, M.H.*

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

Prev. Med. Rep. 26:101700 (2022)

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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.

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