Measures of clinical adiposity and cardiovascular risk

The importance of clinical measures of adiposity (such as body-mass index (BMI), waist circumference and waist-to-hip ratio) in calculating cardiovascular risk remains controversial. For example, both the WHO and the US National Heart, Lung and Blood Institute recommend assessment of BMI; however, several common cardiovascular disease risk scores (eg, PROCAM) omit adiposity measures. In this analysis, the Emerging Risk Factors Collaboration analysed records from 58 prospective studies to determine the separate and combined associations of BMI, waist circumference and waist-to-hip ratio with the risk of first-onset cardiovascular disease.

Individual records were analysed from 221 934 people in 17 countries; serial adiposity measurements were made in 63 821 people. HRs were calculated for each 1 SD higher baseline values for three clinical adiposity measurements: BMI (1 SD=4.56 kg/m²), waist circumference (1 SD=12.6 cm) and waist-to-hip ratio (1 SD=0.083). HRs for cardiovascular disease were 1.23 for BMI, 1.27 for waist circumference and 1.25 for waist-to-hip ratio. Of note, adding information on BMI, waist circumference or waist-to-hip ratio to a cardiovascular disease risk prediction model using conventional risk factors did not significantly improve risk prediction, even …