Is waist-to-height ratio the best predictive indicator of cardiovascular disease incidence in hypertensive adults? A cohort study

Abstract Background Cardiovascular disease (CVD) brings high mortality and economic burden to patients, especially in rural areas. Simple, low-cost abdominal adiposity measures may help identify individuals with increased CVD risk. It is unclear that which obesity indice is the best to predict CVD in hypertensive people. Methods NCRCHS is a prospective cohort study in a general population in Northeast China. The study examined the cardiovascular health from 2013–2015, and follow-up captured the CVD incidence in 2018. Baseline waist-to-height ratio (WHtR), body mass index (BMI),waist-to-hip(WHR)and waist circumference (WC) were calculated and analyzed in relation to the CVD incidence. Results A total of 4244 hypertensive adults without pre-existing CVD at baseline were included in this analysis (age 35–92 years; 2108 men). Over a median follow-up of 4.66 years, a total of 290 CVD cases (6.83%) were documented during the follow-up. Baseline WHtR showed a significant positive association with CVD incidence, even after adjusting for age, sex, diabetes, drinking, smoking, SBP, DBP, Triglyceride, HDL-C, LDL-C, and TC (Hazard Ratios per SD of WHtR ranging from 1.03 to 1.31, p = 0.017). Reclassification and discrimination analyses indicated WHtR addition could improve the conventional model for predicting adverse outcomes within 4 years. Moreover, WHtR predicted the CVD incidence better than other obesity indices (BMI, WC, WHR). Conclusion These findings support a positive association between WHtR and CVD incidence in CVD-free hypertensive adults. WHtR may be useful in predicting CVD incidence in hypertensive adults.

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Is Waist-To-Height Ratio The Best Predictive Indicator of Cardiovascular Disease Incidence in Hypertensive Adults? A Cohort Study

10.21203/rs.3.rs-752424/v1 ◽

2021 ◽

Author(s):

Shu Zhang ◽

Xin Fu ◽

Zhi Du ◽

Xiaofan Guo ◽

Zhao Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Rural Areas ◽

Disease Incidence ◽

Positive Association ◽

Adverse Outcomes ◽

Height Ratio ◽

Cvd Risk ◽

Waist To Height Ratio

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Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

Nutrients ◽

10.3390/nu12020588 ◽

2020 ◽

Vol 12 (2) ◽

pp. 588

Author(s):

Imran Khan ◽

Minji Kwon ◽

Nitin Shivappa ◽

James R. Hébert ◽

Mi Kyung Kim

Keyword(s):

Cardiovascular Disease ◽

Positive Association ◽

Population Based ◽

Proportional Hazard ◽

Dietary Inflammatory Index ◽

Cvd Risk ◽

Inflammatory Index ◽

Cox Proportional Hazard ◽

Increased Risk

Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII®) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]Quintile 5 vs. 1 1.43; 95% CI 1.04–1.96) and in women (HRQuintile 5 vs. 1 1.19; 95% CI 0.85–1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HRQuintile 5 vs. 1 1.80; 95% CI 1.03–3.12), obese men (HRQuintile 5 vs. 1 1.77; 95% CI 1.13–2.76) and men who smoked (HRQuintile 5 vs. 1 1.60; 95% CI 1.10–2.33), respectively. The risk of developing stroke was significantly higher for men (HRQuintile 5 vs. 1 2.06; 95% CI 1.07–3.98; p = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.

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Nomogram to predict risk of incident chronic kidney disease in high-risk population of cardiovascular disease in China: community-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-047774 ◽

2021 ◽

Vol 11 (11) ◽

pp. e047774

Author(s):

Qiuxia Zhang ◽

Jingyi Zhang ◽

Li Lei ◽

Hongbin Liang ◽

Yun Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cox Regression ◽

Validation Cohort ◽

High Risk Population ◽

Cvd Risk ◽

Incident Chronic Kidney Disease

AimsTo develop a nomogram for incident chronic kidney disease (CKD) risk evaluation among community residents with high cardiovascular disease (CVD) risk.MethodsIn this retrospective cohort study, 5730 non-CKD residents with high CVD risk participating the National Basic Public Health Service between January 2015 and December 2020 in Guangzhou were included. Endpoint was incident CKD defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 during the follow-up period. The entire cohorts were randomly (2:1) assigned to a development cohort and a validation cohort. Predictors of incident CKD were selected by multivariable Cox regression and stepwise approach. A nomogram based on these predictors was developed and evaluated with concordance index (C-index) and area under curve (AUC).ResultsDuring the median follow-up period of 4.22 years, the incidence of CKD was 19.09% (n=1094) in the entire cohort, 19.03% (727 patients) in the development cohort and 19.21% (367 patients) in the validation cohort. Age, body mass index, eGFR 60–89 mL/min/1.73 m2, diabetes and hypertension were selected as predictors. The nomogram demonstrated a good discriminative power with C-index of 0.778 and 0.785 in the development and validation cohort. The 3-year, 4-year and 5-year AUCs were 0.817, 0.814 and 0.834 in the development cohort, and 0.830, 0.847 and 0.839 in the validation cohort.ConclusionOur nomogram based on five readily available predictors is a reliable tool to identify high-CVD risk patients at risk of incident CKD. This prediction model may help improving the healthcare strategies in primary care.

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Body Composition and Nuchal Skinfold Thickness in Pediatric Brain Tumor Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1272 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A624-A624

Author(s):

Junxiang Peng ◽

Svenja Boekhoff ◽

Maria Eveslage ◽

Panjarat Sowithayasakul ◽

Brigitte Bison ◽

...

Keyword(s):

Cardiovascular Disease ◽

Body Composition ◽

Brain Tumor ◽

Skinfold Thickness ◽

Healthy Controls ◽

Height Ratio ◽

Tumor Patients ◽

Who Grade ◽

Waist To Height Ratio

Abstract Obesity, cardiovascular disease, and relapse/progression have major impact on prognosis in pediatric brain tumor patients. Cranial MRI is part of routine follow-up. In a cross-sectional study, we analyzed nuchal skinfold thickness (NST) by a standardized method on MRI performed for brain tumor follow-up monitoring as a novel parameter for body composition and cardiovascular disease in 177 brain tumor patients (40 WHO grade 1-2 brain tumors; 31 grade 3-4 brain tumors; 106 craniopharyngioma), and 53 healthy controls. Associations of NST with body mass index (BMI), waist-to-height ratio, caliper-measured skinfold thickness, and blood pressure were analysed in brain tumor patients and healthy controls. Craniopharyngioma patients showed higher BMI, waist-to-height ratio, NST and caliper-measured skinfold thickness when compared with brain tumor patients and healthy controls, whereas these differences were not detectable between brain tumor patients and healthy controls. However, WHO grade 1-2 brain tumor patients were observed with higher BMI, waist circumference and caliper-measured triceps skinfold thickness when compared to WHO grade 3-4 brain tumor patients. NST showed high correlations with BMI, waist-to-height ratio, and caliper-measured skinfold thickness. NST, BMI and waist-to-height ratio had predictive value for cardiovascular disease in terms of increased blood pressure, and in multivariate analysis, only BMI was selected for the final model resulting in an odds ratio of 1.25 (1.14-1.379). In craniopharyngioma patients with hypothalamic involvement/lesion or gross-total resection, rate and degree of obesity were increased. As monitoring of MRI and body composition play an important role in follow-up after brain tumor, we conclude that NST could serve as a novel useful parameter for assessment of body composition and cardiovascular disease risk in brain tumor patients.

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The gender-specific role of prediabetes on 10-year cardiovascular disease incidence: highlights from the ATTICA prospective (2002–2012) study

European Heart Journal ◽

10.1093/ehjci/ehaa946.3040 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Kouvari ◽

D.B Panagiotakos ◽

C Chrysohoou ◽

E.N Georgousopoulou ◽

C Pitsavos ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Prediction ◽

Fasting Glucose ◽

Disease Incidence ◽

Fasting Blood Glucose ◽

Total Sample ◽

Funding Source ◽

Cvd Risk ◽

Diabetes Status

Abstract Background/Introduction Prediabetes in terms of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) are highly discussed for their aggravating effect on cardiac health and their potential inclusion in risk prediction to achieve earlier prevention. Purpose The aim of the present work was to evaluate the association between prediabetes and 10-year first fatal/non fatal cardiovascular disease (CVD) incidence in a sample without prevalent CVD, taking into account the stability of this condition or the transition to type II diabetes. Methods A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. According to American Diabetes Association Diagnosis, prediabetes in terms of IFG was defined as fasting glucose levels 100–125 mg/dl while type 2 diabetes as fasting blood glucose >125 mg/dl or the use of antidiabetic medication. Ten-year follow-up was performed in n=2,020 participants (n=317 CVD cases); the working sample here was n=1,485 (n=249 CVD cases) (without baseline diabetes and with available data on diabetes status at follow-up). Results Of the 1,485 participants, n=279 had IFG, at baseline. Ten-year CVD incidence was 19.3% in IFG subgroup and 12.3% in normoglycemic subgroup (p<0.001); the IFG-to-normoglycemic CVD incidence ratio in men was 1.22 while in women 1.60. Multi-adjusted analysis revealed that IFG was an independent predictor of CVD within the decade (Hazard ratio (HR)=1.39, 95% Confidence Interval (95% CI) (1.00, 1.95)). Significant interacting effect of gender on the examined association was revealed (p for interaction=0.001); in stratified analysis, IFG was independently associated with increased CVD risk only in women (HR=1.47, 95% CI (1.10, 2.68)). Within the decade, transition to diabetes status was observed in about one out of four participants with prediabetes (25.1%) while the respective rate in normoglycemic participants was 10% (n=191 diabetes cases, in total). Interestingly, sensitivity analysis revealed that when this category (with diabetes onset within the decade) was excluded from the analysis prediabetes retained its independent aggravating –even weaker– effect on 10-year CVD risk in total sample (HR=1.18, 95% CI (1.01, 1.91)) as well as in women (HR=1.25, 95% CI (1.03, 2.97)). Conclusion Here, it was suggested that IFG independently predicted long-term CVD onset, even without transition to a more serious cardiometabolic condition (i.e. diabetes) with more evident outcomes in case of women. Considering the increasing interest for early CVD risk prediction, prediabetes condition in terms of IFG may be a useful predictor towards this perspective. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

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Lipoprotein (a) and 10-year Cardiovascular Disease Incidence in Apparently Healthy Individuals: A Sex-based Sensitivity Analysis from ATTICA Cohort Study

Angiology ◽

10.1177/0003319719854872 ◽

2019 ◽

Vol 70 (9) ◽

pp. 819-829 ◽

Cited By ~ 3

Author(s):

Matina Kouvari ◽

Demosthenes B. Panagiotakos ◽

Christina Chrysohoou ◽

Ekavi N. Georgousopoulou ◽

Mary Yannakoulia ◽

...

Keyword(s):

Cardiovascular Disease ◽

Disease Incidence ◽

Density Lipoprotein ◽

Patient Characteristics ◽

Apolipoprotein A1 ◽

Sensitivity Analyses ◽

Cvd Risk ◽

Lipoprotein A ◽

Apparently Healthy

The association between lipoprotein (a) (Lp(a)) and 10-year first fatal/nonfatal cardiovascular disease (CVD) risk in apparently healthy men and women was evaluated. The ATTICA prospective study was conducted during 2001-2012 and included n = 1514 men and n = 1528 women (age >18 years) from the greater Athens area, Greece. Follow-up CVD assessment (2011-2012) was achieved in n = 2020 participants (n = 317 cases); baseline Lp(a) was measured in n = 1890 participants. The recommended threshold of 50 mg/dL was used to define abnormal Lp(a) status. Ten-year CVD-event rate was 14% and 24% in participants with Lp(a) <50 and Lp(a) ≥50 mg/dL, respectively. Multivariate analysis revealed that participants with Lp(a) ≥50 mg/dL versus Lp(a) <50 mg/dL had about 2 times higher CVD risk (hazard ratio (HR) = 2.18, 95% confidence interval (CI) 1.11, 4.28). The sex-based analysis revealed that the independent Lp(a) effect was retained only in men (HR = 2.00, 95% CI 1.19, 2.56); in women, significance was lost after adjusting for lipid markers. Sensitivity analyses revealed that Lp(a) increased CVD risk only in case of abnormal high-density lipoprotein cholesterol, apolipoprotein A1, and triglycerides as well as low adherence to Mediterranean diet. Certain patient characteristics may be relevant when considering Lp(a) as a therapeutic or risk-prediction target.

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The Association of Metabolic Syndrome with the development of cardiovascular disease among Kazakhs in remote rural areas of Xinjiang, China: a cohort study

BMC Public Health ◽

10.1186/s12889-021-10241-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenwen Yang ◽

Shuxia Guo ◽

Haixia Wang ◽

Yu Li ◽

Xianghui Zhang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Cohort Study ◽

Rural Areas ◽

Cox Regression ◽

Baseline Survey ◽

Elevated Blood ◽

Independent Risk Factors ◽

And Control

Abstract Background Metabolic syndrome (MS) can promote the development of cardiovascular disease (CVD). The objective of this study was to examine the association of MS and its components with CVD, to further prevent and control CVD in Kazakhs. Methods In the cohort study, a total of 2644 participants completed the baseline survey between April 2010 and December 2012.The follow-up survey was conducted from April 2016 to December 2016 and was completed by 2286 participants (86.46% follow-up rate). Cox regression was used to evaluate the association of each component and the number of combinations of MS components on the development of CVD. Results A total of 278 CVD patients were enrolled from rural residents of Xinjiang. The average age of the MS and non-MS groups was 46.33 and 38.71 years, respectively. Independent associations with CVD were found for elevated blood pressure (BP) (adjusted hazard ratio (HR) [aHR] = 1.50,95%confidence interval [CI]: 1.08–2.08), elevated waist circumference (WC) (aHR = 1.60, 95%CI: 1.19–2.15), and elevated triglycerides (TG) (aHR = 1.44, 95%CI: 1.04–2.01). Participants with one to 5 MS components had an increased HR for developing CVD, from 1.82to 8.59 (P for trend < 0.001), compared with those with no MS components. The risk of developing CVD increased when TG and WC coexisted (aHR = 2.16, 95%CI: 1.54–3.04)), when TG and BP coexisted ((aHR = 1.92, 95%CI: 1.32–2.79), and when WC and BP coexisted (aHR = 1.93, 95%CI: 1.33–2.82)). However, no significant interactions were found between BP, WC, and TG. Conclusions Elevations of BP, WC, and TG were independent risk factors for CVD in Kazakhs. Control of these factors is important to prevent CVD in this population.

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Gender-Difference in the Association Between Anthropometric Parameters and the Risk Factors of Cardiovascular Diseases in Rural Chinese People: The Handan Eye Study

10.21203/rs.3.rs-37143/v1 ◽

2020 ◽

Author(s):

Juping Liu ◽

Jie Hao ◽

Kai Cao ◽

Ye Zhang ◽

Yuanbo Liang ◽

...

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Density Lipoprotein ◽

Height Ratio ◽

Anthropometric Parameters ◽

Cvd Risk ◽

Cross Sectional ◽

Anthropometric Parameter ◽

Obesity Indices

Abstract Background Body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist/hip/height ratio (WHHR), sagittal abdominal diameter (SAD), and SAD/height ratio (SADHR) are all anthropometric tools used to categorize obesity status. This study aimed to determine associations between different anthropometric indices and the risk of cardiovascular disease (CVD) in Chinese rural areas. Methods The Handan Eye Study is a population-based, longitudinal study. In total, 6830 participants, aged 30 years or older, participated in the baseline study (HES-1). Among them, 5394 subjects of the 6323 survivors (follow-up rate: 85.3%) took part in the 6-year follow-up study (HES-2). As a new anthropometric parameter, SAD was added into HES-2. Meanwhile total cholesterol, high-density lipoprotein protein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and other biochemical data were recorded. This cross-sectional study analyzed these anthropometric obesity indices and correlations with CVD. Prevalence of metabolic syndrome (MS) was used as the indicator of CVD. Results Among the 5394 patients in this study, multivariate analysis revealed higher BMI and WC in women compared to men (24.61 vs. 23.66, p < 0.0001). SAD, WHR, and WHHR showed a smaller correlation to CVD risk factors when compared with other anthropometric parameters. WC and SADHR were more effective predictors of CVD and MS. In men, BMI exhibited a greater proportionality to high-TG (0.693) and hypertension (0.593) and SADHR showed a correlation to low-HDL (0.561) as well as high-glucose (0.664). WC and SADHR were the most effective diagnostic parameters in women. Conclusions Within a rural Chinese population, women were observed to be comparatively more overweight than men. SADHR and BMI serve as effective indicators of CVD and MS in men, whereas SADHR and WC are more effective indicators of CVD and MS in women. Age and gender affect anthropometric obesity indices and correlations with CVD.

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Ideal Cardiovascular Health Metrics Modify the Association Between Exposure to Chinese Famine in Fetal and Cardiovascular Disease: A Prospective Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.751910 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiong Ding ◽

Jinfeng Li ◽

Ying Wu ◽

Peng Yang ◽

Dandan Zhao ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Prospective Cohort ◽

Cardiovascular Health ◽

Cox Regression ◽

Cvd Risk ◽

Fetal Period ◽

Ideal Cardiovascular Health ◽

Famine Exposure

Background: No study has explored the modification effect of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and risk of cardiovascular disease (CVD) so far. We aim to examine the effect of ICVHMs on the association between exposure to famine early in life and the risk of CVD in adulthood.Methods: A total of 61,527 participants free of CVD were included in this study from the Kailuan Study. All participants were divided into three groups, included nonexposed, fetal-exposed, and childhood-exposed groups. Cox regression was used to estimate the effect of famine exposure and ICVHMs on CVD risk.Results: After a median of 13.0 (12.7–13.2) years follow-up, 4,814 incident CVD cases were identified. Compared with nonexposed participants, the CVD risk increased in participants with fetal famine exposure (hazard ratio [HR]: 1.21; 95% CI: 1.07–1.37), but not in childhood famine-exposed participants. After stratifying by the number of ICVHMs, the increased CVD risk associated with fetal famine exposure was only observed in participants with less ICVHMs ( ≤ 2) (HR: 1.30; 95% CI: 1.11–1.52, P for interaction=0.008), but disappeared in those with three or more ICVHMs. The modified effect of ICVHMs was sex specific (P for sex interaction = 0.031).Conclusions: Exposing to famine in the fetal period could increase the risk of CVD in late life; however, ICVHMs might modify the effect of famine exposure on CVD risk, especially in men.

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Association between Soy Food and Dietary Soy Isoflavone Intake and the Risk of Cardiovascular Disease in Women: A Prospective Cohort Study in Korea

Nutrients ◽

10.3390/nu13051407 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1407

Author(s):

Jihyun Im ◽

Kyong Park

Keyword(s):

Cardiovascular Disease ◽

Postmenopausal Women ◽

Premenopausal Women ◽

Soy Isoflavones ◽

Korean Women ◽

Cvd Risk ◽

Soy Isoflavone ◽

Soy Foods ◽

Cardiovascular Disease In Women

The association between soy food and soy isoflavone intake and cardiovascular disease (CVD) risk is uncertain, especially in women. We aimed to investigate this association in Korean women. We analyzed data from the Korean Genome and Epidemiology Study, including 4713 Korean women aged 40–69 years with no CVD or cancer at baseline. Dietary information was obtained using a validated semi-quantitative food frequency questionnaire, and the incidence of CVD was assessed using biennial self-reported questionnaires on medical history. The mean follow-up time was 7.4 years, during which 82 premenopausal and 200 postmenopausal women reported CVD incidence. The highest tofu, total soy foods, and dietary soy isoflavone intake groups were significantly associated with a decreased CVD risk in premenopausal women (tofu: hazard ratio (HR) 0.39; 95% confidence interval (CI), 0.19–0.80; total soy food: HR 0.36; 95% CI, 0.18–0.70; dietary soy isoflavones: HR 0.44; 95% CI, 0.22–0.89), whereas no association was observed in postmenopausal women. Other soy foods showed no association with CVD incidence. Dietary soy isoflavones and total soy foods are associated with a decreased CVD risk in premenopausal women. Among soy foods, only tofu showed significant health benefits.

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