title: BMI vs. waist circumference for identifying vascular risk.
abstract: OBJECTIVE
  Current guidelines recommend measurement of both BMI and waist circumference (WC) in individuals with BMI between 25.0 and 34.9 kg/m(2). We investigated the relative contributions of BMI and WC toward identifying risk of adverse vascular events in a community-based sample.
  
  
  METHODS
  We evaluated Framingham Study participants (n = 4,195 person-examinations, 53% women) using pooled logistic regression to assess the incremental prognostic utility of WC in predicting risk of a first cardiovascular disease (CVD) event in the three BMI categories (normal, <25 kg/m(2); overweight, 25 to <30 kg/m(2); obese, > or =30 kg/m(2)) and to assess the incremental prognostic utility of BMI and WC separately for predicting risk of a first cardiovascular event.
  
  
  RESULTS
  On follow-up (16 years), 430 participants (158 women) had experienced a first CVD event. In overweight women, but not in overweight men, larger WC was found to be an independent predictor of CVD incidence, longitudinally (in women, multivariable-adjusted odds ratio (OR) per s.d. increment in WC 1.86, 95% confidence interval (CI) = 1.03-3.36, P = 0.04; in men adjusted OR per s.d. increment in WC 0.91, 95% CI 0.60-1.38, P = 0.66). In obese individuals and in those with normal BMI, WC was not associated independently with incident CVD. When BMI and WC were analyzed separately for predicting risk of a first cardiovascular event, the c statistics associated with the multivariable CVD models incorporating BMI vs. WC were nearly identical in men and women.
  
  
  CONCLUSIONS
  Knowledge of WC aids identification of vascular risk among overweight women. Among normal weight or obese women and men (regardless of BMI category) WC did not appear to substantially add to prediction of risk of vascular events.
authors.affiliation: Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. freibergms@upmc.edu
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Freiberg
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Katherine
authors.initials: K
authors.lastname: Lanier
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D049629:Waist-Hip Ratio