SCREENING MARKERS

Comparison of BMI, WHpR and lap for identifying hypercholesterolemia, hyperglycemia, hypertension and enhanced atherosclerosis

Abstract

The screening measures to identify various cardiovascular risks related
to hyperglycemia, hypertension and hypercholesterolemia are involves both anatomic
assessments like anthropometric measures or body’s physiological evaluation by performing
biochemical parameters. In this regard “lipid accumulation product” (LAP) has surfaced as a
marker to incorporate both these anatomic and physiological considerations. Objectives: 1. To
measure the LAP differences between subjects having normal and higher levels of glucose, total
cholesterol, age, carotid intima media thickness and subjects with and without hypertension. 2.
To compare BMI and LAP in terms of effectiveness as a screening marker for diagnosis of diabetes
mellitus and hypertension through ROC curve calculation. Design: Cross-sectional analysis.
Place and duration of study: This study was carried out at the departments of pathology, PNS
RAHAT hospital from Jan-2011 to Oct-2011. Subjects and methods: After several exclusions
including know diabetics a total of 202 subjects were enrolled to undergo sampling for Fasting
blood glucose, and lipids in exact medical fasting status. These subjects were later evaluated
for their various anthropometric measurements including BMI and WHpR (Wait to hip ratio) as
per the WHO protocol. Then the individuals went to radiology department where carotid intima
media thickness measurements were made by experienced radiologist. LAP (Lipid accumulation
products) score was calculated as: LAP score (Male) = [WC (cm) - 65] x triglycerides (mmol/L)
LAP score (Female) = [WC (cm) – 58] x triglycerides (mmol/L). LAP scores, BMI. WHpR and
mean CIMT readings were grouped as per their high or low results. Results: Out of BMI, WHpR
and LAP score, only groups based upon LAP score were observed to be significantly different
for fasting blood glucose, total cholesterol and mean CIMT levels. Hypertensive subjects had
higher LAP scores and WHpR than non-hypertensive subjects; however, BMI differences were
not considered significant. One way ANOVA shows the LAP scores progressively rising form
normoglycemic subjects {58.38 (95% CI: 51.08-65.67)} to subjects having IFG {70.94(95%CI:
60.88-81.00)} to newly diagnosed diabetes mellitus {101.59(95%CI: 78.35-124.83)}.[P=0.001]
The AUCs for diagnosing hypertension was higher for LAP scores than for BMI and WHpR
[{(LAP score: 0.648 (95% CI: 0.536-0.760), p= 0.027} vs {(WHpR: 0.588 (95% CI: 0.466-0.709),
p= 0.191} vs {(BMI: 0.541 (95% CI: 0.412-0.670), p=0.545}]. Similarly, the AUCs for BMI and
WHpR were lower than that of LAP score for predicting a diagnosis of diabetes mellitus [{(LAP
score: 0.584 (95% CI: 0.502-0.665), p= 0.047} vs {(BMI: 0.531 (95% CI: 0.448-0.613), p=0.468}
vs {WHpR: 0.518 (95% CI: 0.435-0.601), p=0.668}]. Conclusion: LAP scores were higher
in subjects with established cardiovascular risks like hyperglycemia, hypercholesterolemia,
accelerated atherosclerosis and hypertension that simple anthropometric indices like BMI and
WHpR.