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Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Prediction of cardiovascular disease risk using waist circumference among Aboriginals in a remote Australian community

Authors: Odewumi Adegbija, Wendy Hoy, Zhiqiang Wang

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Elevated waist circumference (WC) is an important risk factor for cardiovascular disease (CVD). Aboriginals in Australia are at higher risk of CVD compared to non-Aboriginals. We examined the association between waist circumference and CVD, and developed a model for projecting absolute risk of cardiovascular disease using WC and age in one high risk Australian Aboriginal community.

Methods

We followed up 920 (470 men, 450 women) participants (more than 80% of the eligible population) aged 18 to 76 years, without CVD at baseline, for up to 20 years. Hazard ratios were estimated using Cox proportional hazards models adjusting for potential confounding factors. Absolute risk was estimated using the Weibull regression model.

Results

Of 920 study participants, 156 males and 177 females developed CVD in the follow-up period. Incidence rates for males and females in the 4th WC quartile (Q4) were 38.3 (95% CI 29.6, 49.7) and 47.2 (95% CI 37.1, 60.3) respectively. Crude hazard ratios of CVD for Q4 WC group using Q1 (quartile 1) as the referent quartile were 2.9 (95% CI 1.8- 4.6) for males and 3.5 (95% CI 2.2- 5.5) for females. Association remained after controlling for age, smoking status and alcohol drinking status (HR = 1.8 for males and HR = 3.1 for females). At 45 years of age with baseline waist circumference of 100 cm, a male had an absolute CVD risk of 32.5%, while a female had a 30.6% risk of the disease.

Conclusions

Risk of CVD among participants increased with increasing WC, and the relationship was accentuated with increasing age. The prediction model provides a tool for understanding the combined effects of WC with age on CVD events in the Australian Aboriginal community. It is simple and easily understood and will assist in identifying individuals at risk of CVD in relation to waist circumference values.
Literature
1.
go back to reference Australian Institute of Health and Welfare, Australia’s Health 2010. The twelfth health report of the Australian Institute of Health and Welfare. Cat. No. AUS 122. Canberra: AIHW; 2010. Australian Institute of Health and Welfare, Australia’s Health 2010. The twelfth health report of the Australian Institute of Health and Welfare. Cat. No. AUS 122. Canberra: AIHW; 2010.
2.
go back to reference Australian Institute of Health and Welfare, Australia’s Health. The thirteenth biennial health report of the Australian Institute of Health and Welfare. Cat. No. AUS 156. Canberra: AIHW; 2012. Australian Institute of Health and Welfare, Australia’s Health. The thirteenth biennial health report of the Australian Institute of Health and Welfare. Cat. No. AUS 156. Canberra: AIHW; 2012.
4.
go back to reference Australian Institute of Health and Welfare. Cardiovascular Disease. Australian facts 2011. 2011; p. 1–232. Australian Institute of Health and Welfare. Cardiovascular Disease. Australian facts 2011. 2011; p. 1–232.
5.
go back to reference Gray C, Brown A, Thomson N. Review of cardiovascular health among Indigenous Australians. Australian Indigenous HealthInfoNet. 2012;9:1–36. Gray C, Brown A, Thomson N. Review of cardiovascular health among Indigenous Australians. Australian Indigenous HealthInfoNet. 2012;9:1–36.
6.
go back to reference Heart Foundation. The shifting burden of cardiovascular disease in Australia. Access Economics, 2005: p. 1–103. Heart Foundation. The shifting burden of cardiovascular disease in Australia. Access Economics, 2005: p. 1–103.
7.
go back to reference Heart Foundation. Absolute cardiovascular disease risk assessment. Heart Foundation Guide to management of hypertension. 2008: p. 1–6. Heart Foundation. Absolute cardiovascular disease risk assessment. Heart Foundation Guide to management of hypertension. 2008: p. 1–6.
8.
go back to reference Li M, McDermott RA. Using anthropometric indices to predict cardio-metabolic risk factors in Australian indigenous populations. Diabetes Res Clin Pract. 2010;87(3):401–6.CrossRefPubMed Li M, McDermott RA. Using anthropometric indices to predict cardio-metabolic risk factors in Australian indigenous populations. Diabetes Res Clin Pract. 2010;87(3):401–6.CrossRefPubMed
9.
go back to reference Kondalsamy-Chennakesavan S, Hoy WE, Wang Z, Briganti E, Polkinghorne K, Chadban S, et al. Anthropometric measurements of Australian Aboriginal adults living in remote areas: comparison with nationally representative findings. Am J Hum Biol. 2008;20(3):317–24.CrossRefPubMed Kondalsamy-Chennakesavan S, Hoy WE, Wang Z, Briganti E, Polkinghorne K, Chadban S, et al. Anthropometric measurements of Australian Aboriginal adults living in remote areas: comparison with nationally representative findings. Am J Hum Biol. 2008;20(3):317–24.CrossRefPubMed
10.
go back to reference Wang Z, Hoy WE. Hypertension, dyslipidemia, body mass index, diabetes and smoking status in Aboriginal Australians in a remote community. Ethn Dis. 2003;13(3):324–30.PubMed Wang Z, Hoy WE. Hypertension, dyslipidemia, body mass index, diabetes and smoking status in Aboriginal Australians in a remote community. Ethn Dis. 2003;13(3):324–30.PubMed
11.
go back to reference Li M, McCulloch B, McDermott R. Metabolic syndrome and incident coronary heart disease in Australian indigenous populations. Obesity (Silver Spring). 2012;20(6):1308–12.CrossRef Li M, McCulloch B, McDermott R. Metabolic syndrome and incident coronary heart disease in Australian indigenous populations. Obesity (Silver Spring). 2012;20(6):1308–12.CrossRef
12.
go back to reference O’Dea K. Body fat distribution and health outcome in Australian Aborigines. Proc Nutr Soc Aust. 1987;12:56–65. O’Dea K. Body fat distribution and health outcome in Australian Aborigines. Proc Nutr Soc Aust. 1987;12:56–65.
13.
go back to reference Adegbija OO, Wang Z. Gender variations in waist circumference levels between aboriginal and non-aboriginal Australian populations: a systematic review. Obesity Research and Clinical Practice. 2014;8:e513–24.CrossRefPubMed Adegbija OO, Wang Z. Gender variations in waist circumference levels between aboriginal and non-aboriginal Australian populations: a systematic review. Obesity Research and Clinical Practice. 2014;8:e513–24.CrossRefPubMed
14.
go back to reference Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, wait-to hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med. 2003;254(6):555–63.CrossRefPubMed Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, wait-to hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med. 2003;254(6):555–63.CrossRefPubMed
15.
go back to reference Wang Z, Hoy WE. Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people. Eur J Clin Nutr. 2004;58(6):888–93.CrossRefPubMed Wang Z, Hoy WE. Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people. Eur J Clin Nutr. 2004;58(6):888–93.CrossRefPubMed
16.
go back to reference Chan LC, Ware RS, Kesting J, Marczak M, Good D, Shaw JT. Association between anthropometric measures of obesity and cardiovascular risk markers in a self-selected group of indigenous Australians. Eur J Cardiovasc Prev Rehabil. 2007;14(4):515–7.CrossRefPubMed Chan LC, Ware RS, Kesting J, Marczak M, Good D, Shaw JT. Association between anthropometric measures of obesity and cardiovascular risk markers in a self-selected group of indigenous Australians. Eur J Cardiovasc Prev Rehabil. 2007;14(4):515–7.CrossRefPubMed
17.
go back to reference Hoy WE, Baker PR, Kelly AM, Wang Z. Reducing premature death and renal failure in Australian aboriginals. A community-based cardiovascular and renal protective program. Med J Aust. 2000;172(10):473–8.PubMed Hoy WE, Baker PR, Kelly AM, Wang Z. Reducing premature death and renal failure in Australian aboriginals. A community-based cardiovascular and renal protective program. Med J Aust. 2000;172(10):473–8.PubMed
18.
go back to reference Wang Z, Hoy WE. Body size measurements as predictors of type 2 diabetes in Aboriginal people. Int J Obes Relat Metab Disord. 2004;28(12):1580–4.CrossRefPubMed Wang Z, Hoy WE. Body size measurements as predictors of type 2 diabetes in Aboriginal people. Int J Obes Relat Metab Disord. 2004;28(12):1580–4.CrossRefPubMed
19.
go back to reference Lear SA, Humphries KH, Birmingham CL. The use of BMI and waist circumference as surrogates of body fat differs by ethnicity. Obesity (Silver Spring). 2007;15(11):2817–24.CrossRef Lear SA, Humphries KH, Birmingham CL. The use of BMI and waist circumference as surrogates of body fat differs by ethnicity. Obesity (Silver Spring). 2007;15(11):2817–24.CrossRef
20.
go back to reference StataCorp. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011. StataCorp. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011.
21.
go back to reference Rexrode KM, Buring JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J of Obes Relat Metab Disord. 2001;27(7):1047–56.CrossRef Rexrode KM, Buring JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J of Obes Relat Metab Disord. 2001;27(7):1047–56.CrossRef
22.
go back to reference Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal Adiposity and coronary heart disease in women. JAMA. 1998;280:p1843–8.CrossRef Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal Adiposity and coronary heart disease in women. JAMA. 1998;280:p1843–8.CrossRef
23.
go back to reference Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995;311(7017):1401–5.CrossRefPubMedPubMedCentral Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995;311(7017):1401–5.CrossRefPubMedPubMedCentral
25.
go back to reference Bamia C, Trichopoulou A, Lenas D, Trichopoulous D. Tobacco smoking in relation to body fat mass and distribution in a general population sample. Int J Obes Relat Metab Disord. 2004;28:p1091–6.CrossRef Bamia C, Trichopoulou A, Lenas D, Trichopoulous D. Tobacco smoking in relation to body fat mass and distribution in a general population sample. Int J Obes Relat Metab Disord. 2004;28:p1091–6.CrossRef
26.
go back to reference Barrett-Connor E, Khaw KT. Cigarette smoking and increased central adiposity. Ann Intern Med. 1989;111:p783–7.CrossRef Barrett-Connor E, Khaw KT. Cigarette smoking and increased central adiposity. Ann Intern Med. 1989;111:p783–7.CrossRef
27.
go back to reference Lean ME, Hans TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. Br Med J. 1995;311:158–61.CrossRef Lean ME, Hans TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. Br Med J. 1995;311:158–61.CrossRef
28.
go back to reference D’Agostino Sr RB, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180–7.CrossRefPubMed D’Agostino Sr RB, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180–7.CrossRefPubMed
29.
go back to reference Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987–1003.CrossRefPubMed Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987–1003.CrossRefPubMed
30.
go back to reference Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew G. The comparative evaluation of waist circumference, waist-to hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes Relat Metab Disord. 2001;25(5):652–61.CrossRefPubMed Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew G. The comparative evaluation of waist circumference, waist-to hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes Relat Metab Disord. 2001;25(5):652–61.CrossRefPubMed
31.
go back to reference Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994;73(7):460–8.CrossRefPubMed Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994;73(7):460–8.CrossRefPubMed
Metadata
Title
Prediction of cardiovascular disease risk using waist circumference among Aboriginals in a remote Australian community
Authors
Odewumi Adegbija
Wendy Hoy
Zhiqiang Wang
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1406-1

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