Original Scientific Paper Using waist circumference as a screening tool to identify colombian subjects at cardiovascular risk Maritza Perez a , Juan P. Casas b , Luz A. Cubillos-Garzo´n b , Norma C. Serrano b , Federico Silva c , Carlos A. Morillo c and Patricio Lo´ pez-Jaramillo b,c,d a Universidad Militar Nueva Granada, b Instituto Colombiano de Investigaciones Biome´ dicas (ICIB), c Fundacio´ n Cardiovascular del Oriente Colombiano and d Universidad Industrial de Santander (UIS), Colombia. Received 14 August 2002 Accepted 8 January 2003 Objective A cut-off value for waist circumference (WC) of 94 cm associated with cardiovascular risk factors (CVRF) has been recommended in Caucasian populations. However, it is unclear if recommendations derived from Western studies should be extrapolated to populations from developing countries. The present study evaluated a group of Colombian subjects to determine and evaluate the level of WC capable of identifying subjects with CVRF. Research design and methods (Study 1) A cross-sectional study in 145 healthy men, to determine the level of WC associated with the following lipid profile (triglycerides 2.25 mmol/L and total-cholesterol/HDL-cholesterol ratio > 5) was performed. (Study 2) Two hundred and thirty-eight unrelated male adults were recruited to test whether the new WC cut-off point would identify subjects with CVRF. Results (Study 1) A WC cut-off point of 88 cm identified subjects with the pre-established lipid profile with a sensitivity of 80.6% and specificity of 80.1%, while the WC of 94 cm had a low sensitivity (48.3%) and a high specificity (93.3%). Additionally, the values of C-reactive protein, fasting glucose and insulin levels in subjects with a WC 88 cm were significantly higher compared to subjects with WC < 88 cm. (Study 2) The diagnostic accuracy of the new WC cut-off point (88 cm) to identify subjects with two or more CVRF remained acceptable in the new sample studied (sensitivity: 83.7% and specificity: 84.8%); while the WC value of 94 cm suggested in Caucasians showed a very low sensitivity (43.2%) and a high specificity (93.9%). Conclusions This study demonstrates a higher prevalence of CVRF in our population at lower levels of WC than those suggested previously in Caucasians, suggesting that ethnic background should be taken into account when using WC as a screener for CVRF. Eur J Cardiovasc Prevention Rehab 10:328–335 c 2003 Lippincott Williams & Wilkins. European Journal of Cardiovascular Prevention and Rehabilitation 2003, 10:328–335 Keywords: epidemiology, abdominal obesity, cardiovascular risk factors, C-reactive protein, Colombia Introduction The World Health Report in 1999 estimated that 78% of the burden of non-communicable diseases and 85% of the cardiovascular disease burden arose from the low and middle-income countries [1]. Additionally, the relatively early age at which cardiovascular disease appears in developing countries leads to an increased disability adjusted by years of life, which in 1990 was 2.8 times higher than that observed in developed countries [2]. In Colombia, the death rate for ischemic heart disease in 20– 84 year old subjects increased from 58.5 per 100 000 in 1980 to 103.2 per 100 000 in 1996. Only 30% of this increase Correspondence and requests for reprints to Dr. Patricio Lo´ pez-Jaramillo, Scientific Director, ICIB; Director Research Institute, Fundacio´ n Cardiovascular del Oriente Colombiano; Associate Professor UIS, Instituto del Corazon Calle 155a No 23–58, Bucaramanga, Colombia. Tel: +577 639 9292; fax: +577 639 2744; e-mail: jplopezj@fcv.org or proyectos_investigacion@fcv.org 1741-8267 c 2003 Lippincott Williams & Wilkins DOI: 10.1097/01.hjr.0000095050.46631.6f Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Downloaded from https://academic.oup.com/eurjpc/article/10/5/328/5934053 by guest on 11 January 2023