Accuracy of Anthropometric Parameters in Identification of High-risk Patients Predicted With Cardiovascular Risk Models

doi:10.1097/MAJ.0b013e31826485de

The American Journal of the Medical Sciences

Volume 346, Issue 1, July 2013, Pages 26-31

https://doi.org/10.1097/MAJ.0b013e31826485de Get rights and content

Abstract

Background

Overweight and obesity are associated with unfavorable outcomes on the cardiovascular system. Early detection of the patients’ high risk for developing cardiovascular disease (CVD) is a primary care priority. Simple-to-use screening tools derived from anthropometric parameters and obesity-related indices could serve this purpose.

Methods

A total of 2,716 women and 1,132 men aged 18 years and older, free of known CVD at baseline were enrolled in this study. Ten-year risk of incident CVD based on 3 computational models, namely Systematic COronary Risk Evaluation (SCORE), United Kingdom Prospective Diabetes Study and Framingham was calculated and served as the main outcome event. Weight, height, body mass index, waist circumference, hip circumference, blood pressure, high-density lipoprotein cholesterol, total cholesterol, serum triglyceride, glycated hemoglobin A1c and fasting plasma glucose concentrations were also determined.

Results

Waist-to-hip ratio (WHR) had the largest area under the curve (AUC) in identification of all outcome variables (high-risk United Kingdom Prospective Diabetes Study, SCORE, Framingham; AUC: 0.64–0.69) in women and in 2 of 3 (SCORE, Framingham; AUC: 0.62–0.64) in men; making it the best parameter followed by waist-to-height ratio and waist circumference. Body mass index and hip circumference consistently produced smaller AUC. WHR optimal cutoff points in prediction of outcome variables were in the range of 0.87 to 0.90 in women and 0.90 to 0.94 in men.

Conclusions

WHR is superior to other anthropometric parameters in identification of high-risk patients based on different CVD risk prediction models and can be used for screening purposes.

Section snippets

Study Population

Medical records of 4516 consecutive patients who visited Vali-Asr hospital diabetes, nutrition and metabolism outpatient clinic (Tehran, Iran) between June 2008 and September 2010 were reviewed. Patients’ medical data were recorded as part of their regular clinical care. No consent form was available for 204 patients. Patients with known history of CVD (n = 376), less than 18 years (n = 29), and those with missing values on any of the anthropometric measures (ie, waist circumference [WC], hip

RESULTS

Table 1 outlines the characteristics of study subjects. Women comprised the majority of study sample (70.6%). Based on UKPDS scoring scheme, 11.5% of women and 32.3% of men had a high 10-year risk for developing CHD. Also, according to SCORE, 4.3% of women and 22.5% of men were classified as high risk for CVD mortality. Finally, using Framingham equation, 13.7% of women and 32.2% of men were classified as high risk for developing CVD in the next 10 years (Table 2). Evaluation of the level of

DISCUSSION

In the present study, ability of anthropometric parameters in identification of patients being at high risk for CVD was investigated. WHR, followed by WHtR, presented better discriminatory ability compared with other indices. Along the same lines, a number of studies have reported that WHR is a better predictor of CVD risk factors. In a study of 1587 men, Yan et al²⁷ observed that compared with BMI, WHR is a better predictor of subclinical atherosclerosis (AUC = 0.65) evaluated via carotid

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We used the waist-to-hip ratio (WHR) as an indicator of obesity. For WHR, the cut-off points in the Iranian population were applied for categorizing “normal” and “abnormal” values (0.92 for men and 0.88 for women).23 Descriptive analyses were performed to report baseline characteristics of the population.
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The WHR is likely the major risk factor for the development of type 2 diabetes30 and it is a very important factor in determining those at high risk of prediabetes cases. Furthermore, WHR seems to be the best marker in predicting cardiovascular outcomes that result from many chronic diseases.31–33 The metabolic changes happened during hyperglycemic state might cause an increase in the reactive oxygen species (ROS) where polyol pathway is activated.
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Obesity is a main factor in the development of metabolic syndrome (MS). Obesity and MS are associated with increased oxidative stress that might cause damage to cellular biomolecules including DNA. So, we aimed of this study to assess the DNA damage in obese women with MS.
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Among the obese women with MS, 20% of cases met criteria for polycystic ovary syndrome (PCOS). The percent of DNA damage was significantly higher in MS patients as well as in the subgroup of MS with PCOS than in controls. A significant association was determined between the frequency of DNA damage and some anthropometric measurements. Where, body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR) showed significant association with the frequency of DNA damage. Moreover, the mean of DNA damage frequency might be influenced by the presence of combined metabolic components within MS cases. Cases with the combination of hypertension plus dyslipidemia as well as cases with the combination of hypertension plus dyslipidemia plus elevated fasting glucose showed higher levels of DNA damage than those without.
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To investigate whether our proposed cutoff points of obesity indicators predict the occurrence of hypertension (HT), diabetes mellitus (DM), and hyperlipidemia in premenopausal women with greater sensitivity and specificity compared to reference cutoff points of obesity that are currently being used.
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: The authors declare no conflict of interest.

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Clinical InvestigationAccuracy of Anthropometric Parameters in Identification of High-risk Patients Predicted With Cardiovascular Risk Models