Waist circumference does not improve established cardiovascular disease risk prediction modeling

• Published in: PloS one 2020-10, Vol.15 (10), p.e0240214-e0240214
• Main Authors: Nelms, Matthew W, Day, Andrew G, Sui, Xuemei, Blair, Steven N, Ross, Robert
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Biology and Life Sciences; Biomarkers; Blood pressure; Body Mass Index; Body weights and measures; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cholesterol; Continuity (mathematics); Correlation analysis; Diabetes; Exercise; Family medical history; Female; Follow-Up Studies; Glucose; Health aspects; Health risks; Heart diseases; Humans; Hypertension; Kinesiology; Male; Medicine and Health Sciences; Middle Aged; Models, Statistical; Mortality; Physical Sciences; Population; Prediction models; Predictive Value of Tests; Reclassification; Research and Analysis Methods; Risk; Risk Assessment; Risk factors; Smoking; Umbilicus; Waist Circumference; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240214

Despite considerable evidence demonstrating that waist circumference (WC) is independently associated with cardiovascular disease (CVD) and/or all-cause mortality, whether the addition of WC improves risk prediction models is unclear. The objective was to evaluate the improvement in risk prediction with the addition of WC, alone or in combination with BMI, to the Framingham Risk Score (FRS) and a population specific model. 34,377 men and 9,477 women aged 20 to 79 years who completed a baseline examination at the Cooper Clinic (Dallas, TX) during 1977-2003 and enrolled in the Aerobics Center Longitudinal Study (ACLS). WC was measured at the level of the umbilicus and expressed as a continuous variable. Deaths among participants were identified using the National Center for Health Statistics National Death Index. A total of 728 fatal cardiovascular disease (CVD) events occurred over a mean follow-up period of 13.1 ± 7.5 years. WC was significantly higher in CVD decedents (P = .002). The FRS C-statistic for fatal CVD in men was 0.836 (0.816-0.855) and 0.883 (0.851-0.915) in women. The addition of WC did not improve the C-statistic in men (0.831 (0.809-0.853)) or women (0.883 (0.850-0.916)). Similar findings were observed for non-fatal CVD and all-cause mortality, and when WC was added to a population specific model. Upon adding WC, the net-reclassification index was 0.024 with an integrated discrimination improvement of -0.0004. The addition of WC, alone or in combination with BMI, did not substantively improve risk prediction for CVD or all-cause mortality compared to the Framingham Risk Score or a population specific model.