Ethnicity and the association between anthropometric indices of obesity and cardiovascular risk in women: a cross-sectional study

Objectives: The objectives of this study were to determine whether the cross-sectional associations between anthropometric obesity measures, body mass index (BMI), waist circumference (WC) and waist-to hip ratio (WHR), and calculated 10-year cardiovascular disease (CVD) risk using the Framingham and general CVD risk score models, are the same for women of Australian, UK and Ireland, North European, South European and Asian descent. This study would investigate which anthropometric obesity measure is most predictive at identifying women at increased CVD risk in each ethnic group. Design: Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Setting: Population-based survey in Australia. Participants: 4354 women aged 20–69 years with no history of heart disease, diabetes or stroke. Most participants were of Australian, UK and Ireland, North European, South European or Asian descent (97%).Outcome measures: Anthropometric obesity measures that demonstrated stronger predictive ability of identifying women at increased CVD risk and likelihood of being above the promulgated treatment thresholds of various risk score models. Results: Central obesity measures, WC and WHR, were better predictors of cardiovascular risk. WHR reported a stronger predictive ability than WC and BMI in Caucasian women. In Northern European women, BMI was a better indicator of risk using the general CVD (10% threshold) and Framingham (20% threshold) risk score models. WC was the most predictive of cardiovascular risk among Asian women. Conclusions: Ethnicity should be incorporated into CVD assessment. The same anthropometric obesity measure cannot be used across all ethnic groups. Ethnic-specific CVD prevention and treatment strategies need to be further developed

A Prospective Study of Abdominal Obesity and Coronary Artery Calcium Progression in Older Adults

Objective: Little is known about obesity measurements and coronary artery calcium (CAC) progression in older adults. We examined the sex-specific association between measures of body size and fat distribution with CAC progression

CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.

Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias. A group of scientists and editors developed the CONSORT (Consolidated Standards of Reporting Trials) statement to improve the quality of reporting of RCTs. It was first published in 1996 and updated in 2001. The statement consists of a checklist and flow diagram that authors can use for reporting an RCT. Many leading medical journals and major international editorial groups have endorsed the CONSORT statement. The statement facilitates critical appraisal and interpretation of RCTs. During the 2001 CONSORT revision, it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports. A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement. After an expert meeting in January 2007, the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement. This update improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition, such as selective outcome reporting bias. This explanatory and elaboration document-intended to enhance the use, understanding, and dissemination of the CONSORT statement-has also been extensively revised. It presents the meaning and rationale for each new and updated checklist item providing examples of good reporting and, where possible, references to relevant empirical studies. Several examples of flow diagrams are included. The CONSORT 2010 Statement, this revised explanatory and elaboration document, and the associated website (www.consort-statement.org) should be helpful resources to improve reporting of randomised trials

Accounting for time-dependent treatment use when developing a prognostic model from observational data : A review of methods

Failure to account for time-dependent treatment use when developing a prognostic model can result in biased future predictions. We reviewed currently available methods to account for treatment use when developing a prognostic model. First, we defined the estimands targeted by each method and examined their mechanisms of action with directed acyclic graphs (DAGs). Next, methods were implemented in data from 1,906 patients; 325 received selective β-blockers (SBBs) during follow-up. We demonstrated seven Cox regression modeling strategies: (a) ignoring SBB treatment; (b) excluding SBB users or (c) censoring them when treated; (d) inverse probability of treatment weighting after censoring (IPCW), including SBB treatment as (e) a binary or (f) a time-dependent covariate; and (g) marginal structural modeling (MSM). Using DAGs, we demonstrated IPCW and MSM have the best properties and target a similar estimand. In the case study, compared to (a), approaches (b) and (e) provided predictions that were 1% and 2% higher on average. Performance (c-statistic, Brier score, calibration slope) varied minimally between approaches. Our review of methods confirmed that ignoring treatment is theoretically inferior, but differences between the prediction models obtained using different methods can be modest in practice. Future simulation studies and applications are needed to assess the value of applying IPCW or MSM to adjust for treatments in different treatment and disease settings