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Appropriate Cut-Off Values of Waist Circumference to Predict Cardiovascular Outcomes: 7-Year Follow-Up in an Iranian Population Publisher Pubmed



Talaei M1, 3 ; Thomas NG1 ; Marshall T1 ; Sadeghi M2 ; Iranipour R3 ; Oveisgharan S3 ; Sarrafzadegan N3
Authors
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Authors Affiliations
  1. 1. Public Health, Epidemiology and Biostatistics, University of Birmingham, United Kingdom
  2. 2. Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Iran
  3. 3. Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Iran

Source: Internal Medicine Published:2012


Abstract

Objective Due to the lack of compelling evidence for waist circumference (WC) as a cardiovascular disease (CVD) risk factor in many ethnic groups, the need for local research has been expressed by international authorities. This study was undertaken to determine the optimal cut-off points of WC for predicting incident CVD and metabolic syndrome in an Iranian population. Materials and Methods A total of 6,504 participants from three areas in central Iran were followed over 7 years. Receiver operating characteristics (ROC) and area under the curve (AUC) were used to identify the maximum value of sensitivity and specificity combinations corresponding to the appropriate cut-off points of WC for the detection of the metabolic syndrome and CVD events. The optimal cut-off values were defined as the point at which the value of sensitivity+specificity-1 reached the maximum value. Finally, Cox proportional hazard modeling was used to determine which cut-off point was better fit in the CVD risk prediction model. Results After 394,418 person-years of follow-up, 427 incident primary CVD events (233 men) were identified. Considering CVD, the optimum cut-off points were 99/103.5 cm (men/women) but these had a low sensitivity (AUC: 0.59, 95%CI 0.55-0.63 in both men and women). The second highest values for discriminating CVD were 93/97 cm that resulted in acceptable sensitivity. Regarding the metabolic syndrome, 92.6/97.8 cm were identified as optimum (AUC: 0.67, 95%CI 0.65-0.69 in men and 0.65, 95%CI 0.63-0.67 in women). The best cut-off values that fit in the Cox regression model were 90/97 cm. Conclusion International recommended WC cut-off values for the Middle East are not appropriate compared to the locally defined cut-off values in Iran. © 2012 The Japanese Society of Internal Medicine.
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