Appropriate Cut-off Values of Waist Circumference to Predict Cardiovascular Outcomes: 7-year Follow-up in an Iranian Population

M Talaei, Graham Thomas, Tom Marshall, M Sadeghi, R Iranipour, S Oveisgharan, N Sarrafzadegan

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    10 Citations (Scopus)


    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.
    Original languageEnglish
    Pages (from-to)139-146
    Number of pages8
    JournalInternal Medicine
    Issue number2
    Publication statusPublished - 1 Jan 2012


    • Iran
    • cardiovascular disease
    • metabolic syndrome
    • waist circumference
    • cut-off point


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