Body mass index (BMI) could make predicting cardiovascular disease (CVD) risk easier and more accurate if it were to replace cholesterol levels in prediction models, according to a research letter published online on November 12, 2012, in Archives of Internal Medicine
The authors of the letter note that cholesterol levels, which are a typical risk factor in CVD prediction models along with smoking status and blood pressure, are frequently unavailable in electronic health records (EHRs). This makes calculating CVD risk difficult for many patients. By contrast, the authors note, height and weight are commonly included in EHRs, so they compared the European SCORE prediction model with a version in which BMI replaced cholesterol levels.
The authors drew risk factor data from 17,791 individuals 16 years and older who participated in either of 2 CVD studies based in Switzerland and drew mortality follow-up data from the Swiss National Cohort. Compared with the cholesterol model, the BMI model showed higher risks at all ages and better discriminated between those at high and low CVD risk. The synergistic effects of BMI were stronger than cholesterol levels in combination with smoking and particularly with blood pressure. In a combined model with cholesterol, BMI remained a significant predictor of risk, whereas cholesterol did not.