Adiposity is a poor portent of cardiovascular disease

A new analysis finds that measurements of body mass index (BMI), waist circumference, and waist-to-hip ratio might not be as valuable in predicting cardiovascular disease as previously thought. After analyzing 58 prospective studies, researchers from the United Kingdom concluded that whether they are assessed singly or in combination, these adiposity measures do not improve the risk prediction provided by systolic blood pressure, history of diabetes, and lipid profiles in people from developed countries.

Records of more than 220,000 people with no known history of cardiovascular disease from 17 countries were analyzed. Mean age of participants at baseline was 58 years, and they were almost evenly split between men and women.

The researchers found that in people with a BMI of 20 kg/m² or higher, hazard ratios (HRs) for cardiovascular disease were 1.23 (95% CI, 1.17-1.29) with BMI; 1.27 (95% CI, 1.20-1.33) with waist circumference; and 1.25 (95% CI, 1.19-1.31) with waist-to-hip ratio after adjusting for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1.07 (95% CI, 1.03-1.11) with BMI; 1.10 (95% CI, 1.05-1.14) with waist circumference; and 1.12 (95% CI, 1.08-1.15) with waist-to-hip ratio. Adding measurements of BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not significantly improve risk discrimination. Combining adiposity measures resulted in similar findings.

Emerging Risk Factors Collaboration, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085-1095.