The predictive value of different measures of obesity for incident cardiovascular events and mortality

J Clin Endocrinol Metab. 2010 Apr;95(4):1777-85. doi: 10.1210/jc.2009-1584. Epub 2010 Feb 3.


Context: To date, it is unclear which measure of obesity is the most appropriate for risk stratification.

Objective: The aim of the study was to compare the associations of various measures of obesity with incident cardiovascular events and mortality.

Design and setting: We analyzed two German cohort studies, the DETECT study and SHIP, including primary care and general population.

Participants: A total of 6355 (mean follow-up, 3.3 yr) and 4297 (mean follow-up, 8.5 yr) individuals participated in DETECT and SHIP, respectively.

Interventions: We measured body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) and assessed cardiovascular and all-cause mortality and the composite endpoint of incident stroke, myocardial infarction, or cardiovascular death.

Results: In both studies, we found a positive association of the composite endpoint with WHtR but not with BMI. There was no heterogeneity among studies. The relative risks in the highest versus the lowest sex- and age-specific quartile of WHtR, WC, WHR, and BMI after adjustment for multiple confounders were as follows in the pooled data: cardiovascular mortality, 2.75 (95% confidence interval, 1.31-5.77), 1.74 (0.84-3.6), 1.71 (0.91-3.22), and 0.74 (0.35-1.57), respectively; all-cause mortality, 1.86 (1.25-2.76), 1.62 (1.22-2.38), 1.36 (0.93-1.69), and 0.77 (0.53-1.13), respectively; and composite endpoint, 2.16 (1.39-3.35), 1.59 (1.04-2.44), 1.49 (1.07-2.07), and 0.57 (0.37-0.89), respectively. Separate analyses of sex and age groups yielded comparable results. Receiver operating characteristics analysis yielded the highest areas under the curve for WHtR for predicting these endpoints.

Conclusions: WHtR represents the best predictor of cardiovascular risk and mortality, followed by WC and WHR. Our results discourage the use of the BMI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Anthropometry
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / mortality*
  • Cohort Studies
  • Education
  • Endpoint Determination
  • Female
  • Germany / epidemiology
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Obesity / complications
  • Obesity / diagnosis*
  • Obesity / mortality*
  • Population
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Regression Analysis
  • Sex Factors
  • Smoking / epidemiology
  • Socioeconomic Factors
  • Young Adult