title: Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex--results from two community based cohort studies.
abstract: OBJECTIVE
  To study waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), and waist-hip-height ratio (WHHR) as predictors of CVD, in men and women stratified by BMI (cut-off ≥25).
  
  
  RESULTS
  A cohort of n = 3741 (53% women) 60-year old individuals without CVD was followed for 11-years (375 CVD cases). To replicate the results, we also assessed another large independent cohort; The Malmö Diet and Cancer study - cardiovascular cohort (MDCC, (n = 5180, 60% women, 602 CVD cases during 16-years). After adjustment for established risk factors in normal-weight women, the hazard ratio (HR) per one standard deviation (SD) were; WHR; 1.91 (95% confidence interval (CI) 1.35-2.70), WC; 1.81 (95% CI 1.02-3.20), SAD; 1.25 (95% CI 0.74-2.11), and WHHR; 1.97 (95% CI 1.40-2.78). In men the association with WHR, WHHR and WC were not significant, whereas SAD was the only measure that significantly predicted CVD in men (HR 1.19 (95% CI 1.04-1.35). After adjustments for established risk factors in overweight/obese women, none of the measures were significantly associated with CVD risk. In men, however, all measures were significant predictors; WHR; 1.24 (955 CI 1.04-1.47), WC 1.19 (95% CI 1.00-1.42), SAD 1.21 (95% CI 1.00-1.46), and WHHR; 1.23 (95% CI 1.05-1.44). Only the findings in men with BMI ≥ 25 were verified in MDCC.
  
  
  CONCLUSIONS
  In normal weight individuals, WHHR and WHR were the best predictors in women, whereas SAD was the only independent predictor in men. Among overweight/obese individuals all measures failed to predict CVD in women, whereas WHHR was the strongest predictor after adjustments for CVD risk factors in men.
authors.affiliation: Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. Electronic address: axelcefam@hotmail.com.
authors.forename: A C
authors.initials: AC
authors.lastname: Carlsson
authors.affiliation: Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Riserus
authors.affiliation: Department of Public Health and Caring Sciences/Section of Geriatrics Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Ärnlöv
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Y
authors.initials: Y
authors.lastname: Borné
authors.affiliation: Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Leander
authors.affiliation: Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Gigante
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M-L
authors.initials: ML
authors.lastname: Hellénius
authors.affiliation: Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Bottai
authors.affiliation: Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: de Faire
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D064346:Sagittal Abdominal Diameter; D012737:Sex Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio
keywords: Body mass index; Epidemiology; Gender; Incident cardiovascular disease; Sagittal abdominal diameter; Waist-hip-height ratio