title: Neck circumference and future cardiovascular events in a high-risk population--A prospective cohort study.
abstract: BACKGROUND
  The distribution of adipose tissue has been evaluated in relation to cardiovascular risk factors and biochemical components of the metabolic syndrome. Neck circumference (NC) has been shown to have a strong relationship with cardiovascular disease (CVD) and may be a novel indicator of CVD. The aim of this study was to compare the incidence of CVD events in cohorts with different NC distributions, and to correlate NC with future CVD events and relative mortality.
  
  
  METHODS
  A prospective cohort study was performed on 12,151 high-risk cardiology outpatients from 2004 until 2014. Anthropometric parameters like body mass index, NC, waist circumference, and hip circumference were measured at baseline and follow-up and compared in different cohorts with high, medium, and low NC. Fatal and non-fatal CVD events were compared in the follow-up study, and survival analysis was conducted. Independent Chi-square tests were performed to compare the incidence of CVD events and mortality among the cohorts and analyze the interactions.
  
  
  RESULTS
  The subjects comprised of 6696 women and 5819 men who completed a mean 8.8-year follow-up. All of the participants had two or more CVD risk factors at baseline. At the end of the study, 4049 CVD events had occurred in 2304 participants. The incidence of non-fatal CVD events was 14.08, 16,65, and 25.21 % in the low-NC, medium-NC, and high-NC cohorts, respectively (p < 0.001). The all-cause mortality was 9.77, 11.93, and 19.31 %, and CVD mortality, 4.00, 6.29, and 8.01 %, respectively (p < 0.001). Compared with baseline, the number of CVD risk factors in participants had increased from 2.6, 3.0, and 3.4 to 3.5, 4.1, and 4.7 in the low-, medium-, and high-NC cohorts (34, 36, and 38 %), respectively. The event-free survival rate was 95.32, 80.15, and 75.47 %, respectively.
  
  
  CONCLUSIONS
  A higher NC indicated a higher incidence of future fatal and non-fatal CVD events and all-cause mortality in both male and female high-risk participants. CVD risk factors increased more in the higher NC group. NC as a novel indicator of CVD showed good predictive ability for CVD events and mortality in a high-risk population.
authors.affiliation: The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China.
authors.forename: Yingnan
authors.initials: Y
authors.lastname: Dai
authors.affiliation: The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China.
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Wan
authors.affiliation: The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China.
authors.forename: Enze
authors.initials: E
authors.lastname: Jin
authors.affiliation: The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China. hmu.xueqili@outlook.com.
authors.forename: Xueqi
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D049628:Body Size / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D011446:Prospective Studies; D055105:Waist Circumference / Q000502:physiology; D049629:Waist-Hip Ratio