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The Impact of Waist Circumference on Incident of Cardiovascular Death During 9 Years of Follow Up in General Population


 Background: Risk assessment is essential for the primary prevention of cardiovascular death among general population. Although studies have shown that waist circumference (WC) is positively associated with an increased risk of cardiovascular death among the general population, few studies have investigated the prognostic value of WC during a long-term follow up and the risk threshold of WC remains controversial. We aimed to investigate whether higher level of WC measurements was able to predict mortality in general population.Methods: In this prospective cohort study, a total of 1521 consecutive subjects free of clinical cardiovascular disease were included. The end point was cardiovascular death. The Kaplan-Meier method was used to evaluate the cumulative risk of outcome at different WC levels, and compared by log-rank tests. Univariate and multivariable-adjusted Cox regression models were used to investigate the association between WC and outcomes.Results: During a median follow up of 9.2 years, there were 265 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of WC (WC> 94cm) had a significantly increased risk of cardiovascular death (log-rank p＜0.001). After adjustment for potential confounders, multiple COX regression models showed that higher level of WC was an independent predictor in developing cardiovascular death (HR 3.02; 95% CI: 1.88–3.83; p＜0.001). We saw a significant increase of (area under the curve) AUC in ROC (receiver operating characteristic) curve after addition of WC to a clinical model, for long-term cardiovascular death the increase of AUC 0.766 vs 0.642 (95% CI: 0.787–0.846 p＜0.001). The addition of WC to established risk factors significantly improved risk prediction of cardiovascular death (net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusion: Higher level of WC is significantly associated with long-term cardiovascular death. WC may provide incremental prognostic value beyond traditional risks factors.