The impact of using sagittal abdominal diameter to predict major cardiovascular events in European patients with type 2 diabetes

What is already known?•Central obesity is particularly dangerous and associated with deteriorating metabolic health and diabetes type 2.•BMI does not distinguish lean body mass from adiposity.•Consensus about SAD cut-offs for predicting CVD risk is lacking.What does this study add?•Sagittal abdominal diameter >25 cm may be used to identify risk individuals for cardiovascular disease in type 2 diabetes.

Background and aimsObesity is associated with diabetes type 2 and one of the most important risk factors for cardiovascular disease. We explored if sagittal abdominal diameter (SAD) is a better predictor of major cardiovascular events than waist circumference (WC) and body mass index (BMI) in type 2 diabetes.Methods and resultsThe CARDIPP study consists of a cohort of patients with type 2 diabetes. In this study we used data from 635 participants with no previous myocardial infarction or stroke, with a mean follow-up time of 7.1 years. SAD, WC and BMI were measured at baseline and the end-point was first cardiovascular event, measured as a composite of ICD-10 codes for acute myocardial infarction, stroke or cardiovascular mortality. SAD was significantly higher in the major cardiovascular event group compared to participants that did not suffer a major cardiovascular event during follow-up (p < 0.001). SAD >25 cm was the only anthropometric measurement that remained associated with major cardiovascular events when adjusted for modifiable and non-modifiable factors (hazard ratio 2.81, 95% confidence interval 1.37-5.76, p = 0.005).ConclusionSAD with the cut off level of >25 cm, if confirmed in larger studies, may be used as a more independent risk-assessment tool compared with WC in clinical practice, to identify persons with type 2 diabetes at high cardiovascular risk. ClinicalTrials.gov: NCT01049737.