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Appropriate Cut-off Values of Waist Circumference to Predict Cardiovascular Outcomes: 7-year Follow-up in an Iranian Population
Mohammad Talaei 1,3, G Neil Thomas 1, Tom Marshall 1, Masoumeh Sadeghi 2
,Rokhsareh Iranipour 3, Shahram Oveisgharan 3 and Nizal Sarrafzadegan 3
１Public Health, Epidemiology & Biostatistics, University of Birmingham, U.K., ２Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Iran and ３Cardiovascular Research Center, Isfahan Cardiovascular Research Institute,
Isfahan University of Medical Sciences, Iran
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: rea under the curve (AUC) were used to identify theA total of 6,504 participants from three areas in central Iran were followed over 7
years. Receiver operating characteristics (ROC) and a
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 identi fied. 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. Key words: waist circumference, cut-off point, cardiovascular disease, metabolic syndrome, Iran
How to Cite
Mohammad Talaei , G Neil Thoma, Tom Marshall, Masoumeh Sadeghi
,Rokhsareh Iranipour , Shahram Oveisgharan and Nizal Sarrafzadegan.Appropriate Cut-off Values of Waist Circumference toPredict Cardiovascular Outcomes: 7-year Follow-up in an Iranian Population.January 2012Internal Medicine 51(2):139-46. doi:10.10110.2169/internalmedicine.51.6132. PMID: 22246480.