Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project

Victoria Rosberg; Julie KK Vishram-Nielsen; Anna M.Dyrvig Kristensen; Manan Pareek; Thomas S.G. Sehested; Peter M. Nilsson; Allan Linneberg; Luigi Palmieri; Simona Giampaoli; Chiara Donfrancesco; Frank Kee; Giuseppe Mancia; Giancarlo Cesana; Giovanni Veronesi; Guido Grassi; Kari Kuulasmaa; Veikko Salomaa; Tarja Palosaari; Susana Sans; Jean Ferrieres; Jean Dallongeville; Stefan Söderberg; Marie Moitry; Wojciech Drygas; Abdonas Tamosiunas; Annette Peters; Hermann Brenner; Ben Schöttker; Sameline Grimsgaard; Tor Biering-Sørensen; Michael H. Olsen

doi:10.1016/j.pmedr.2022.101700

Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project

Victoria Rosberg
, Julie KK Vishram-Nielsen^*
, Anna M.Dyrvig Kristensen
, Manan Pareek
, Thomas S.G. Sehested
, Peter M. Nilsson
, Allan Linneberg
, Luigi Palmieri
, Simona Giampaoli
, Chiara Donfrancesco
, Frank Kee
, Giuseppe Mancia
, Giancarlo Cesana
, Giovanni Veronesi
, Guido Grassi
, Kari Kuulasmaa
, Veikko Salomaa
, Tarja Palosaari
, Susana Sans
, Jean Ferrieres

Jean Dallongeville, Stefan Söderberg, Marie Moitry, Wojciech Drygas, Abdonas Tamosiunas, Annette Peters, Hermann Brenner, Ben Schöttker, Sameline Grimsgaard, Tor Biering-Sørensen, Michael H. Olsen

^*Corresponding author for this work

IRS - Holbæk Hospital, Research Unit of Medicine (Holbæk)

Nordsjællands Hospital
University of Copenhagen
Zealand University Hospital, Roskilde
Lund University
Istituto Superiore di Sanità - National Center for Epidemiology, Surveillance and Health Promotion
Queen's University Belfast
University of Milano-Bicocca
University of Insubria
National Institute for Health and Welfare
Catalan Department of Health
Institut Pasteur de Lille
Umeå University
University Hospitals of Strasbourg
Heidelberg University
German Cancer Research Center
UiT The Arctic University of Norway
Copenhagen University Hospital
Bispebjerg and Frederiksberg Hospitals
Yale New Haven Hospital
University of Toulouse
National Institute of Cardiology, Warsaw, Poland.
Lithuanian University of Health Sciences
Institute of Human Genetics, Helmholtz Zentrum München
Steno Diabetes Center Sjaelland, Akacievej 7, DK-4300, Holbaek, Denmark.

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUC_ROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUC_ROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.

Original language	English
Article number	101700
Journal	Preventive Medicine Reports
Volume	26
Number of pages	9
ISSN	2211-3355
DOIs	https://doi.org/10.1016/j.pmedr.2022.101700
Publication status	Published - Apr 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s)

Funding

The MORGAM Project has received funding from EU projects MORGAM (Biomed, BMH4-CT98-3183), GenomEUtwin (FP5, QLG2-CT-2002-01254), ENGAGE (FP7, HEALTH-F4-2007-201413), CHANCES (FP7, HEALTH-F3-2010-242244), BiomarCaRE (FP7, HEALTH-F2-2011-278913), euCanSHare (Horizon 2020, No. 825903) and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research Council, London (G0601463, No. 80983: Biomarkers in the MORGAM Populations). This has supported central coordination, workshops and part of the activities of the MORGAM Data Centre, the MORGAM Laboratories and the MORGAM Participating Centres. VS was supported by the Finnish Foundation for Cardiovascular Research. SSg was supported by the Swedish Heart and Lung foundation and by the County council of V?stertbotten. MP has the followings relationships ? Advisory Board and Speaking Honoraria: AstraZeneca; Speaking Honoraria: Bayer, Boehringer Ingelheim.

Keywords

Adipose tissue
Assessment, risk
Body mass index
Cardiovascular diseases
Cholesterol
Waist-hip ratio

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Rosberg, V., Vishram-Nielsen, J. KK., Kristensen, A. M. D., Pareek, M., Sehested, T. S. G., Nilsson, P. M., Linneberg, A., Palmieri, L., Giampaoli, S., Donfrancesco, C., Kee, F., Mancia, G., Cesana, G., Veronesi, G., Grassi, G., Kuulasmaa, K., Salomaa, V., Palosaari, T., Sans, S., ... Olsen, M. H. (2022). Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project. Preventive Medicine Reports, 26, Article 101700. https://doi.org/10.1016/j.pmedr.2022.101700

@article{ded3669513c9485e91bcb6687956d5e4,

title = "Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project",

abstract = "To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53\% men) from the MORGAM-Project, aged 19{\textendash}97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.",

keywords = "Adipose tissue, Assessment, risk, Body mass index, Cardiovascular diseases, Cholesterol, Waist-hip ratio",

author = "Victoria Rosberg and Vishram-Nielsen, \{Julie KK\} and Kristensen, \{Anna M.Dyrvig\} and Manan Pareek and Sehested, \{Thomas S.G.\} and Nilsson, \{Peter M.\} and Allan Linneberg and Luigi Palmieri and Simona Giampaoli and Chiara Donfrancesco and Frank Kee and Giuseppe Mancia and Giancarlo Cesana and Giovanni Veronesi and Guido Grassi and Kari Kuulasmaa and Veikko Salomaa and Tarja Palosaari and Susana Sans and Jean Ferrieres and Jean Dallongeville and Stefan S{\"o}derberg and Marie Moitry and Wojciech Drygas and Abdonas Tamosiunas and Annette Peters and Hermann Brenner and Ben Sch{\"o}ttker and Sameline Grimsgaard and Tor Biering-S{\o}rensen and Olsen, \{Michael H.\}",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2022",

month = apr,

doi = "10.1016/j.pmedr.2022.101700",

language = "English",

volume = "26",

journal = "Preventive Medicine Reports",

issn = "2211-3355",

publisher = "Elsevier",

}

Rosberg, V, Vishram-Nielsen, JKK, Kristensen, AMD, Pareek, M, Sehested, TSG, Nilsson, PM, Linneberg, A, Palmieri, L, Giampaoli, S, Donfrancesco, C, Kee, F, Mancia, G, Cesana, G, Veronesi, G, Grassi, G, Kuulasmaa, K, Salomaa, V, Palosaari, T, Sans, S, Ferrieres, J, Dallongeville, J, Söderberg, S, Moitry, M, Drygas, W, Tamosiunas, A, Peters, A, Brenner, H, Schöttker, B, Grimsgaard, S, Biering-Sørensen, T & Olsen, MH 2022, 'Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project', Preventive Medicine Reports, vol. 26, 101700. https://doi.org/10.1016/j.pmedr.2022.101700

Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project. / Rosberg, Victoria; Vishram-Nielsen, Julie KK; Kristensen, Anna M.Dyrvig et al.
In: Preventive Medicine Reports, Vol. 26, 101700, 04.2022.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures

T2 - The MORGAM prospective cohort project

AU - Rosberg, Victoria

AU - Vishram-Nielsen, Julie KK

AU - Kristensen, Anna M.Dyrvig

AU - Pareek, Manan

AU - Sehested, Thomas S.G.

AU - Nilsson, Peter M.

AU - Linneberg, Allan

AU - Palmieri, Luigi

AU - Giampaoli, Simona

AU - Donfrancesco, Chiara

AU - Kee, Frank

AU - Mancia, Giuseppe

AU - Cesana, Giancarlo

AU - Veronesi, Giovanni

AU - Grassi, Guido

AU - Kuulasmaa, Kari

AU - Salomaa, Veikko

AU - Palosaari, Tarja

AU - Sans, Susana

AU - Ferrieres, Jean

AU - Dallongeville, Jean

AU - Söderberg, Stefan

AU - Moitry, Marie

AU - Drygas, Wojciech

AU - Tamosiunas, Abdonas

AU - Peters, Annette

AU - Brenner, Hermann

AU - Schöttker, Ben

AU - Grimsgaard, Sameline

AU - Biering-Sørensen, Tor

AU - Olsen, Michael H.

PY - 2022/4

Y1 - 2022/4

N2 - To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.

AB - To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.

KW - Adipose tissue

KW - Assessment, risk

KW - Body mass index

KW - Cardiovascular diseases

KW - Cholesterol

KW - Waist-hip ratio

U2 - 10.1016/j.pmedr.2022.101700

DO - 10.1016/j.pmedr.2022.101700

M3 - Journal article

C2 - 35141116

AN - SCOPUS:85123786731

SN - 2211-3355

VL - 26

JO - Preventive Medicine Reports

JF - Preventive Medicine Reports

M1 - 101700

ER -

Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project

Abstract

Bibliographical note

Funding

Keywords

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