BRI shows stronger association than BMI for MACE in patients with T2DM: insights from the ACCORD study
Maojun Liu1, Junyu Pei1, Cheng Zeng1
1Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Insights
Elevated body roundness index (BRI) significantly increases cardiovascular events and mortality risk in type 2 diabetes patients. BRI is a better predictor than BMI for these adverse outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Type 2 diabetes mellitus (T2DM) is associated with increased cardiovascular risk.
- Traditional obesity indices like BMI may not fully capture metabolic risks.
- The body roundness index (BRI) is a novel anthropometric measure of central obesity.
Purpose of the Study:
- To investigate the association between BRI and major adverse cardiovascular events (MACEs) and total mortality (TM) in patients with T2DM.
- To compare the predictive power of BRI with body mass index (BMI) for cardiovascular outcomes.
- To identify potential risk thresholds for BRI in this patient population.
Main Methods:
- Analysis of data from the ACCORD/ACCORDION cohort.
- Cox proportional hazards regression models to assess BRI and BMI associations with MACEs and TM.
- Non-linear analysis using restricted cubic splines and smooth curve-fitting.
- Subgroup and sensitivity analyses for result validation.
Main Results:
- Elevated BRI was a significant independent risk factor for MACEs and TM in T2DM patients.
- A unit increase in BRI correlated with a 3% higher risk of MACEs and a 6% higher risk of TM.
- The highest BRI tertile showed significantly increased MACEs and TM risk compared to the lowest tertile.
- No significant association was found between BMI and MACEs in multivariate analysis.
- Non-linear relationships identified, with inflection points for cardiovascular mortality and TM.
Conclusions:
- Elevated BRI is significantly associated with increased risk of MACEs and TM in T2DM patients.
- BRI demonstrates potential as a valuable tool for cardiovascular risk assessment in T2DM.
- BRI may offer superior risk prediction compared to BMI for adverse outcomes in T2DM.
Objective:
This study investigated the associations of the body roundness index (BRI) with major adverse cardiovascular events (MACEs, including non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death) and total mortality (TM) in patients with type 2 diabetes mellitus (T2DM) from the ACCORD/ACCORDION cohort.
Methods:
During a median follow-up of 8.82 years, a total of 1,802 participants (17.76%) experienced MACEs, and 1,926 participants (18.98%) died from all causes. We used Cox proportional hazards regression models to evaluate the association of BRI and body mass index (BMI) with MACEs and TM. Non-linear dynamics between BRI and these outcomes were probed via restricted cubic spline and smooth curve-fitting, identifying pivotal risk thresholds. Comprehensive subgroup and sensitivity analyses were implemented to validate the consistency of the results.
Results:
The findings from multivariate Cox regression models, after adjusting for potential confounders, indicated that elevated BRI levels were a significant risk factor for MACEs and TM. A unit rise in BRI was associated with a 3% heightened risk of MACEs and a 6% increase in TM. Patients in the highest tertile of baseline BRI faced a 1.14 fold and a 1.27 fold elevated risk of MACEs and TM, respectively, relative to those in the lowest tertile. In contrast, the same multivariate regression analysis showed no significant association between baseline BMI quartiles and MACEs. Notably, the associations of BRI with MACEs and TM were comparable to those observed for the waist-to-height ratio (WHtR) and the conicity index. Additionally, our analysis delineated a nonlinear correlation between BRI and both types of mortality, pinpointing inflection points at 4.39 for cardiovascular mortality and 4.24 for TM via a recursive methodology.
Conclusion:
An elevated BRI was significantly associated with a higher risk of MACEs and TM in our cohort of patients with T2DM. BRI may serve as a useful indicator for assessing cardiovascular risk in patients with T2DM.
Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT00000620, NCT00000620.
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