Accuracy of Anthropometric Indicators of Obesity to Predict Cardiovascular Risk

Abstract

CONTEXT: Obesity is associated with various cardiovascular risk factors. The body mass index (BMI) is the standard measure of overweight and obesity. However, more recently, waist to hip ratio (WHR) or waist circumference (WC) as more sensitive measures for visceral obesity have been proposed to be more indicative of cardiovascular risk. OBJECTIVE: This study was performed to test the predictive value of anthropometric parameters for the presence of several cardiovascular risk conditions. DESIGN: The DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) study is a cross-sectional, clinical-epidemiological study. PARTICIPANTS: We studied 5377 unselected subjects (2016 men, 3361 women) without arteriosclerotic disease, aged 20-79 yr, from the DETECT laboratory sample. SETTING: This study was conducted by primary care physicians. INTERVENTION: We measured anthropometric parameters and assessed cardiovascular risk by clinical examination, patient history, and a standardized laboratory program. MAIN OUTCOME MEASURES: We assessed the associations of BMI, WC, hip circumference, WHR, and waist to height ratio (WHtR) to cardiovascular risk by calculating the area under the receiver-operating characteristic curve and adjusted odds ratios for metabolic syndrome, dyslipidemia, and type 2 diabetes. RESULTS: The area under the receiver-operating characteristic curve for WHtR was significantly higher than for all other anthropometric parameters with respect to all risk conditions in women and to dyslipidemia and type 2 diabetes in men. The odds ratios for the presence of risk conditions with 1 sd increase of each anthropometric parameter were highest for WHtR or WC. CONCLUSIONS: There are some indications that WHtR or WC may predict prevalent cardiovascular risk better than BMI or WHR, even though the differences are small.