Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type-2 diabetes: a prospective cohort study from ADVANCE.
OBJECTIVE
The aim of this study was to compare the strength of associations and discrimination capability of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with cardiovascular disease risk in individuals with type-2 diabetes.


RESULTS
Eleven thousand, one hundred and forty men and women were followed for a mean of 4.8 years. The Cox proportional hazard models were used to compute the hazard ratios and 95% confidence intervals (95% CI) for one standard deviation (SD) increase in baseline BMI (SD: 5 kg/m2), WC (SD: 13 cm) and WHR (SD: 0.08) with cardiovascular disease risk. After adjustment, hazard ratio (95% CI) for WC were 1.10 (1.03–1.18) for cardiovascular events, 1.13 (1.03–1.24) for coronary events, and 1.08 (0.98–1.19) for cardiovascular deaths. Estimates for WHR were 1.12 (1.05–1.19), 1.17 (1.08–1.28) and 1.19 (1.09–1.31). BMI was not related to any of these outcomes. Although the receiver operating characteristic curve could not differentiate between anthropometric variables (P values 0.24), the relative integrated discrimination improvement statistic showed an enhancement in the discrimination capabilities of models using WHR for cardiovascular outcomes, except for cerebrovascular events.


CONCLUSIONS
Strengths of associations and discrimination statistics suggested that WHR was the best predictor of cardiovascular events and mortality in patients with type-2 diabetes and BMI the worst.
Czernichow
Sébastien
S
The George Institute for International Health, The University of Sydney, New South Wales, Australia. czernichow@uren.smbh.univ-paris13.fr
Kengne
Andre-Pascal
AP
Huxley
Rachel R
RR
Batty
George David
GD
de Galan
Bastiaan
B
Grobbee
Diederick
D
Pillai
Avinesh
A
Zoungas
Sophia
S
Marre
Michel
M
Woodward
Mark
M
Neal
Bruce
B
Chalmers
John
J
D050154:Adiposity; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio