A, A critical thinking. Why when using anthropometrics in predicting myocardial infarction risk medical research and cardiology were always in error?: Arguments evidencing biases

A critical thinking. Why when using anthropometrics in predicting myocardial infarction risk medical research was always confused?: We evidence association biases

Authors

  • Angel Martin Castellanos Angel Cardiovascular Sciences Center

DOI:

https://doi.org/10.14738/jbemi.91.11662

Keywords:

Myocardial infarction, cardiovascular disease, risk prediction, obesity, anthropometric, bias.

Abstract

Cardiovascular diseases (CVDS) mainly heart disease and stroke are the leading causes of death globaly. Obesity is a major risk factor for myocardial infarction (MI). However, how to measure whole-risk with simple baseline anthropometric characteristics? Anthropometrically, association for metrics does not equate causation on incident MI/CVD. Besides, a different body composition between groups with similar baseline confounding variables may provide false-positives in outcomes. Thus, in predicting whole-risk all metrics are not enterely valid, and the lack of balance between the simple body measurements will be particularly prone to the generation of false-positive results. Baseline characteristics of thousands of MI cases are well known, but anthropometry and mathematics have taught us novel something. Thus, our findings reveal that anthropometrically-associated risk would appear biased if metrics to compare had no balance and equivalence relation for the whole-risk. WHR and waist circumference, present association biases when whole-risk is not conditioned on the covariate that receives true-risk. It occurs for unbalancing body measurements when healthy and cases were compared worlwide. It is clear, in any risk cutoff for WHR <1 and WHtR >0.5 is always fullfilled: HC >WC >height/2, and therefore occurring protective overestimation of hip circumference respect to waist circumference and height as well as risk overestimation for waist concerning height. Only waist-to-height ratio as being directly associated to a realtive volume of risk yields no biases and should be the metric correctelly used to predict the anthropometrically-measured whole-risk in both sexes. Our arguments are mathematically demonstrable.

References

GBD 2017. Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2018. 392(10159): p. 1736-1788. doi: 10.1016/S0140-6736(18)32203-7. 2. World Health Organization (WHO). The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed Nov 11, 2021.

World health organization (WHO). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed Nov 11, 2021. 4. Lassale C, Tzoulaki I, Moons KGM, Sweeting M, Boer J, Johnson L, et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Eur Heart J, 2018. 39 (5): p. 397-406 5. Yusuf S, Hawken S, Ounpuu S. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 2004. 364: p. 937-952. 6. Egeland GM, Igland J, Vollset SE, Sulo G, Eide GE, Tell GS. High population attributable fractions of myocardial infarction associated with waist-hip ratio. Obesity, 2016. 24 (5): p. 1162-9. 7. Cao Q, Yu S, Xiong W, et al. Waist-hip ratio as a predictor of myocardial infarction risk. A systematic review and meta-analysis. Medicine, 2018. p. 27-30 (e11639). doi.org/10.1097/MD.00000000000116 39 8. Peters SAE, Bots SH, Woodward M. Sex Differences in the Association Between Measures of General and Central Adiposity and the Risk of Myocardial Infarction: Results From the UK Biobank. J Am Heart Assoc, 2018. 7(5). pii: e008507. doi: 10.1161/JAHA.117.008507. 9. Martin-Castellanos A, Martin-Castellanos P, Martin E, Barca Duran FJ. Abdominal obesity and myocardial infarction risk: We demonstrate the anthropometric and mathematical reasons that justify the association bias of waist-to-hip ratio. Nutr Hosp, 2021. 38 (3): p. 502-510. http://dx.doi.org/10.20960/nh.03416. https://pubmed.ncbi.nlm.nih.gov/33757289. Accessed Nov 12, 2021. 10. Choi D, Choi S, Son JS, Oh SW, Park SM. Impact of Discrepancies in General and Abdominal Obesity on Major Adverse Cardiac Events. J Am Heart Assoc, 2019. 8 (18):e013471. DOI: 10.1161/JAHA.119.013471 11. Liu J, Tse LA, Liu Z, et al. PURE (Prospective Urban Rural Epidemiology) study in China. Predictive Values of Anthropometric Measurements for Cardiometabolic Risk Factors and Cardiovascular Diseases among 44 048 Chinese. J Am Heart Assoc, 2019. 8 (16):e010870. doi: 10.1161/JAHA. 118.010870. 12. Dhar S, Das PK, Bhattacharjee B, Awal A, Ahsan SA, Shakil SS, et al. Predictive Value of Waist Height Ratio, Waist Hip Ratio and Body Mass Index in Assessing Angiographic Severity of Coronary Artery Disease in Myocardial Infarction Patients. Mymensingh Med J, 2020. 29 (4): p. 906-913. 13. Castellanos, AM. Anthropometric measures in predicting myocardial infarction risk. Do we know what we are measuring? Bias in research occurred worldwide when the true unhealthy body composition was not well compared. MRA, 2021. 9 (6): p. 1-19. https://doi.org/10.18103/mra.v9i6.2447. Available at: https://esmed.org/MRA/mra/article/view/2447. Accessed Nov 12, 2021. 14. Woolcott OO, Bergman RN. Relative fat mass (RFM) as a new estimator of whole-body fat percentage ─ A crosssectional study in American adult individuals. Scientific Reports, 2018. 8 (1):10980.doi:10.1038/s41598- 018-29362-1. 15. Martin-Castellanos A, Martin-Castellanos P, Cabañas MD, et al. Adiposity-Associated Anthropometric Indicators and Myocardial Infarction Risk: Keys for Waist to-Height-Ratio as Metric in Cardiometabolic Health. AJFNH, 2018. 3 (5): p. 100-107.

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Published

2022-02-09

How to Cite

Angel, A. M. C. (2022). A, A critical thinking. Why when using anthropometrics in predicting myocardial infarction risk medical research and cardiology were always in error?: Arguments evidencing biases : A critical thinking. Why when using anthropometrics in predicting myocardial infarction risk medical research was always confused?: We evidence association biases . British Journal of Healthcare and Medical Research, 9(1), 22–31. https://doi.org/10.14738/jbemi.91.11662