Neck Circumference and 10-Year Cardiovascular Risk at the Baseline of the ELSA-Brasil Study: Difference by Sex

Silva, Acácia Antônia Gomes de Oliveira; Araujo, Larissa Fortunato de; Diniz, Maria de Fátima Haueisen Sander; Lotufo, Paulo Andrade; Bensenor, Isabela Martins; Barreto, Sandhi Maria; Giatti, Luana

doi:10.36660/abc.20190289

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Original Article • Arq. Bras. Cardiol. 115 (5) • Nov 2020 • https://doi.org/10.36660/abc.20190289 copy

Neck Circumference and 10-Year Cardiovascular Risk at the Baseline of the ELSA-Brasil Study: Difference by Sex

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Neck circumference (NC), an indirect measure of upper-body subcutaneous adipose tissue, has been pointed out as an independent predictor of cardiometabolic diseases.

Objectives:

To assess the association between NC and 10-year cardiovascular risk in men and in women.

Methods:

Cross-sectional analysis of 13,920 participants of the (baseline) Longitudinal Study of Adult Health (ELSA-Brasil). The association between NC (used as continuous variable and grouped into quartiles) and the 10-year cardiovascular risk was estimated by the Framingham Global Risk Score and analyzed by generalized linear models after adjustments for sociodemographic characteristics, health behaviors, body mass index and waist circumference. The significance level adopted was 5%.

Results:

Mean NC was 39.5 cm (SD± 3.6) in men and 34.0 cm (SD±2.9) in women. After adjustments, a one-centimeter increase in NC was associated with an increment of 3% (95%CI1.02-1.03) and 5% (95% 1.04-1.05) in the arithmetic mean of the 10-year CVD risk in men and women, respectively. Men and women in the last quartile showed an increment of 18% (95%CI 1.13-1.24) and 35% (95%CI 1.28-1.43), respectively in the arithmetic mean of the 10-year CVD risk, after adjustments.

Conclusions:

We found a positive, independent association between NC and the 10-year cardiovascular disease risk. NC may contribute to the prediction of cardiovascular risk, over and above traditional anthropometric measures.

Keywords:
Cardiovascular Diseases; Risk Factors; Gender; Adiposity; Cardiovacular Risk

Characteristics		Men		Women		p value
		(n=6,261)		(n=7,659)
		n	%	n	%
Age (years)
	35-44	1,481	23.7	1,708	22.3	0.009^* * Pearson's chi-square test,
	45-54	2,518	40.2	3,086	40.3
	55-64	1,634	26.1	2,165	28.3
	65-75	628	10.0	700	9.1
Self-reported race/skin color
	White	3,299	52.7	3,981	52	<0.001^* * Pearson's chi-square test,
	Pardo	1,888	30.2	2,041	26.7
	Black	870	13.9	1,351	17.6
	Yellow	120	1.9	225	2.9
	Indigenous	84	1.3	61	0.8
Educational attainment
	Completed higher school	3,162	50.5	4,245	55.4	<0.001^* * Pearson's chi-square test,
	Completed high school	2,094	33.5	2,744	35.8
	Completed elementary school	516	8.2	396	5.2
	Some elementary school	489	7.8	274	3.6
Alcohol consumption
	Moderate	3,994	63.8	4,673	61.0	<0.001^* * Pearson's chi-square test,
	None/former user	1,486	23.7	2,718	35.5
	Heavy drinking	781	12.5	268	3.5
Leisure-time physical activity
	Mild	4,596	73.4	6,100	79.7	<0.001^* * Pearson's chi-square test,
	Moderate	1086	17.4	1,143	14.9
	High	579	9.2	416	5.4
Body mass index (BMI) (Kg/m²2. Karpe F, Pinnick KE. Biology of upper-body and lower-body adipose tissue-link to whole-body phenotypes. Nat Rev Endocrinol. 2014;11(2):90-100.)
	Normal weight	2,179	34.8	3,040	39.7	<0.001^* * Pearson's chi-square test,
	Overweight	2,819	45.0	2,756	36.0
	Obesity	1,263	20.2	1,863	24.3
Waist circumference (cm)
	Adequate	4,662	74.5	4,270	55.7	<0.001^* * Pearson's chi-square test,
	Inadequate	1,599	25.5	3,389	44.3
Neck circumference (cm), mean (±SD)		39,5	(±3.6)	34,0	(±2.9)	<0.001^† † unpaired t-test,
10-year cardiovascular risk score (%), median (1st/3rd quartile)		11,3	(6.2- 19.9)	4,4	(2.4-8.3)	<0.001^‡ ‡ Mann-Whitney test.

Risk factors	Men (n=6.261)		Women (n=7.659)		p value
Age (years), mean (±SD)	51.7	±11.5	51.8	±10.0	0.53^† † unpaired t-test,
Total cholesterol (mg/dL), median (1^st and 3^rd quartiles)	210	(185-239)	214	(189-241)	<0.001^‡ ‡ Mann-Whitney test.
HDL cholesterol (mg/dL), median (1^st and 3^rd quartiles)	49	(43-57)	60	(51-70)	<0.001^‡ ‡ Mann-Whitney test.
Use of antihypertensive agents, n (%)	1.687	26.9	2.071	27.0	0.90^* * Pearson chi-square test,
Systemic arterial pressure, mean (±SD)	125.3	±20.9	117.2	±18.9	<0.001^† † unpaired t-test,
Diabetics, n (%)	1.200	19.2	1.068	14.0	<0.001^* * Pearson chi-square test,
Smokers, n (%)	889	14.4	927	12.1	<0.001^* * Pearson chi-square test,

	Men	Women
	AMR (95%CI)	AMR (95%CI)
Model 0	1.05 (1.04 – 1.05)	1.11 (1.10 – 1.12)
Model 1	1.06 (1.05 – 1.06)	1.09 (1.08 – 1.10)
Model 2	1.06 (1.05 – 1.06)	1.09 (1.08 – 1.10)
Model 3	1.03 (1.02 – 1.04)	1.07 (1.06 – 1.08)
Model 4	1.03 (1.02 – 1.03)	1.05 (1.04– 1.06)

	Men AMR (95%CI)				Women AMR (95%CI)
	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
Model 0	1.00	1.14(1.08-1.21)	1.21(1.14-1.28)	1.42(1.34-1.51)	1.00	1.23(1.16-1.31)	1.59(1.49-1.70)	2.04(1.91-2.18)
Model 1	1.00	1.14(1.10-1.19)	1.30(1.25-1.35)	1.52(1.47-1.58)	1.00	1.16(1.11-1.21)	1.37(1.31-1.43)	1.78(1.71-1.86)
Model 2	1.00	1.14(1.10-1.18)	1.28(1.24-1.33)	1.49(1.43-1.54)	1.00	1.16(1.11-1.20)	1.36(1.30-1.41)	1.76(1.69-1.84)
Model 3	1.00	1.07(1.04-1.11)	1.16(1.11-1.21)	1.24(1.18-1.30)	1.00	1.10 (1.06-1.15)	1.25(1.19-1.31)	1.50(1.42-1.58)
Model 4	1.00	1.05(1.02-1.09)	1.12(1.08-1.17)	1.18(1.13-1.24)	1.00	1.06(1.02-1.11)	1.17(1.12-1.23)	1.35(1.28-1.43)

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