title: Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study.
abstract: OBJECTIVE
  The aim of this study was to compare novel and established anthropometrical measures in their ability to predict cardiovascular disease (CVD), and to determine whether they improve risk prediction beyond classical risk factors in a cohort study of 60-year-old men and women. We also stratified the results according to gender to identify possible differences between men and women. Furthermore, we aimed to replicate our findings in a large independent cohort (The Malmö Diet and Cancer study-cardiovascular cohort).
  
  
  METHODS
  This was a population-based study of 1751 men and 1990 women, aged 60 years and without CVD at baseline, with 375 incident cases of CVD during 11 years of follow-up. Weight, height, waist circumference (WC), hip circumference and sagittal abdominal diameter (SAD) were measured at baseline. Body mass index (BMI), waist-hip ratio (WHR), waist-hip-height ratio (WHHR), WC-to-height ratio (WCHR) and SAD-to-height ratio (SADHR) were calculated.
  
  
  RESULTS
  All anthropometric measures predicted CVD in unadjusted Cox regression models per s.d. increment (hazard ratios, 95% confidence interval), while significant associations after adjustments for established risk CVD factors were noted for WHHR 1.20 (1.08-1.33), WHR 1.14 (1.02-1.28), SAD 1.13 (1.02-1.25) and SADHR 1.17 (1.06-1.28). WHHR had higher increases in C-statistics, and model improvements (likelihood ratio tests (P<0.001)). In the replication study (MDC-CC, n=5180), WHHR was the only measure that improved Cox regression models in men (P=0.01).
  
  
  CONCLUSIONS
  WHHR, a new measure reflecting body fat distribution, showed the highest risk estimates after adjustments for established CVD risk factors. These findings were verified in men but not women in an independent cohort.
authors.affiliation: 1] Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden [2] Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: A C
authors.initials: AC
authors.lastname: Carlsson
authors.forename: U
authors.initials: U
authors.lastname: Risérus
authors.forename: G
authors.initials: G
authors.lastname: Engström
authors.forename: J
authors.initials: J
authors.lastname: Ärnlöv
authors.forename: O
authors.initials: O
authors.lastname: Melander
authors.forename: K
authors.initials: K
authors.lastname: Leander
authors.forename: B
authors.initials: B
authors.lastname: Gigante
authors.forename: M-L
authors.initials: ML
authors.lastname: Hellénius
authors.forename: U
authors.initials: U
authors.lastname: de Faire
mesh_terms: D001823:Body Composition; D050218:Body Fat Distribution / Q000706:statistics & numerical data; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000473:pathology; D009765:Obesity / Q000453:epidemiology* / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D055105:Waist Circumference; D049629:Waist-Hip Ratio