doi: 10.1161/01.CIR.0000161801.65408.8D
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(Circulation. 2005;111:1883-1890.)
© 2005 American Heart Association, Inc.
Epidemiology |
Enlarged Waist Combined With Elevated Triglycerides Is a Strong Predictor of Accelerated Atherogenesis and Related Cardiovascular Mortality in Postmenopausal Women
From the Prospective Epidemiological Risk Factors Study Group, Center for Clinical and Basic Research, Ballerup (L.B.T., Y.Z.B., G.Q., P.A., C.C.), and Rheoscience, Rødovre (P.J.L.), Denmark.
Reprint requests to László B. Tankó, MD, PhD, Center for Clinical and Basic Research, Ballerup Byvej 222, 2750 Ballerup, Denmark. E-mail lbt{at}ccbr.dk
Received October 12, 2004; revision received February 3, 2005; accepted February 9, 2005.
Background— Upward trends of obesity urge more effective identification of those at cardiovascular risk. A simple dichotomous indicator, enlarged waist (
88 cm) combined with elevated triglycerides (1.45 mmol/L) (EWET), was shown to offer advantages in identifying individuals with atherogenic "lipid overaccumulation" compared with other indicators, including the metabolic syndrome defined by the National Cholesterol Education Program (MS-NCEP). Whether EWET offers superior disease and event prediction in postmenopausal women, however, remains unknown.
Methods and Results— A community-based sample of 557 women (48 to 76 years of age) were followed up for 8.5±0.3 years to assess the utility of EWET and MS-NCEP in estimating the risk of all-cause and cardiovascular mortality and the annual progression rate of aortic calcification. At baseline, 15.8% of women had EWET and 17.6% had MS-NCEP. All-cause mortality and cardiovascular mortality were increased in carriers of the dichotomous indicators (P<0.001). After adjustment for age, smoking, and LDL cholesterol, presence of EWET was associated with a 4.7-fold (95% CI, 2.2 to 9.8; P<0.001) increased risk and presence of MS-NCEP was associated with a 3.2-fold (95% CI, 1.5 to 6.5; P<0.001) increased risk for fatal cardiovascular events. Exclusion of women with prevalent diabetes did not change these trends; respective hazard ratios were 4.2 (95% CI, 1.9 to 9.3; P<0.001) and 2.5 (95% CI, 1.1 to 5.5; P<0.05). Among those who were discordant for EWET and MS-NCEP at baseline, those who had EWET alone (n=21) had a higher annual progression rate of aortic calcification compared with those who had MS-NCEP alone (n=31; P<0.05).
Conclusions— The combined presence of EWET may be the best indicator of cardiovascular risk in postmenopausal women. Other components of the MS-NCEP add little medical value to screening in general practices.
Key Words: atherosclerosis • diagnosis • lipids • obesity • women
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