Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project.
Fiche publication
Date publication
avril 2022
Journal
Preventive medicine reports
Auteurs
Membres identifiés du Cancéropôle Est :
Dr MOITRY Marie
Tous les auteurs :
Rosberg V, Vishram-Nielsen JK, Kristensen AMD, Pareek M, Sehested TSG, Nilsson PM, 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 MH
Lien Pubmed
Résumé
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 (AUC), 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 (AUC 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.
Mots clés
ACM, all-cause mortality, ASCVD, atherosclerotic cardiovascular disease, AUCROC, area under the receiver-operating-characteristic curve, Adipose tissue, Assessment, risk, BMI, body mass index, BP, blood pressure, Body mass index, CEP, composite cardiovascular endpoint, CI, confidence interval, CV, cardiovascular, CVD, cardiovascular disease, CVM, cardiovascular mortality, Cardiovascular diseases, Chol, serum total cholesterol, Cholesterol, DBP, diastolic blood pressure, EFM, estimated fat mass, HDL-cholesterol, high density lipoprotein cholesterol, HR, hazard ratio, IQR, interquartile range, MACE, major adverse cardiovascular events, MBP, mean blood pressure, MONICA, Multi-national MONItoring of Trends and Determinants in CArdiovascular Disease, MORGAM, MOnica, Risk, Genetics, Archiving and Monograph, NRI, net reclassification improvement, NS, non-significant, PP, pulse pressure, SBP, systolic blood pressure, SCORE, Systematic COronary Risk Evaluation, WHR, waist-hip ratio, Waist-hip ratio, cNRI, continuous net reclassification improvement
Référence
Prev Med Rep. 2022 Apr;26:101700