Author(s): Santos, Maria ; Sousa-Uva, Mafalda ; Namorado, Sónia ; Gonçalves, Teresa ; Matias Dias, Carlos ; Gaio, Vânia
Date: 2023
Persistent ID: http://hdl.handle.net/10400.18/8838
Origin: Repositório Científico do Instituto Nacional de Saúde
Subject(s): Cardiovascular Risk; Anthropometric Indices; INSEF 2015; Risco Cardiovascular; Medidas antropométricas; Determinantes da Saúde e da Doença; Estados de Saúde e de Doença; Portugal
Introduction: The relationship between abdominal obesity and cardiovascular risk is well established. The objective of this study was to determine the best anthropometric index to assess cardiovascular risk in the Portuguese population aged 40-69 years. Materials and methods: Data from the 1st National Health Examination Survey 2015 were used. The analyzed anthropometric indices included Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Height Ratio (WHtR), Waist-to-Hip Ratio (WHR), and A Body Shape Index (ABSI). The subsample consisted of 2780 individuals who met the inclusion criteria: aged 40-69 years, not pregnant, available information on sex, age, smoking status, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and anthropometric measures (weight, height, WC, hip circumference). Individuals receiving cancer treatment were not included in the study. Those with a previous diagnosis of acute myocardial infarction, stroke, diabetes, chronic kidney disease, or undergoing medication therapy for these conditions were excluded from the analysis due to their already high or very high cardiovascular risk, being the use of SCORE2 inappropriate. The area under the curve (AUC) of the receiver operating characteristic (ROC) was calculated, stratified by sex, to determine the best index for assessing cardiovascular risk. Results: In females, WHR exhibited the highest discriminatory power with an AUC of 0.67 (95% CI: 0.63 to 0.71), closely followed by WHtR with an AUC of 0.66 (95% CI: 0.61 to 0.70) and ABSI with an AUC of 0.65 (95% CI: 0.60 to 0.70). In males, WHtR displayed the highest discriminatory power with an AUC of 0.64 (95% CI: 0.59 to 0.68), closely followed by WHR with an AUC of 0.63 (95% CI: 0.58 to 0.67), and WC had an AUC of 0.62 (95% CI: 0.57 to 0.67). Discussion: Previous research has produced diverse findings regarding the choice of anthropometric indices, with variations across genders. In the present study the AUC values for the analyzed indices encountered for both genders had overlapping confidence intervals, indicating no statistically significant difference in predictive power. Conclusion: In women, the best index was WHR, and in men it was WHtR. However, due to a lack of statistical significance, it was not possible to determine which index had the best predictive ability. Nevertheless, this doesn't invalidate the previously well-established link between abdominal obesity and cardiovascular risk. Cardiovascular disease has a multifactorial etiology, and attempting to find only one variable that predicts the risk of a cardiovascular event can be overly simplistic and limiting.
