Time to Retire the BMI? Evaluating Abdominal Adipose Tissue Imaging as Novel Cardiovascular Risk Biomarker ∗

Body mass index (BMI) is the currently recommended adiposity-related biomarker for identifying individuals at elevated risk of cardiovascular disease (CVD), type 2 diabetes, and all-cause mortality (American College of Cardiology/American Heart Association Class I, Level of Evidence: B) (1). If one were to evaluate critically the performance of BMI as a biomarker, however, it would fall short in several areas. First, although higher BMI grossly identifies individuals in the population at increased risk for mortality, those who are overweight or mildly obese may have lower or similar mortality compared with normal-weight individuals (2). Second, approximately one-third of obese adults are metabolically healthy (defined as 0 or 1 cardiometabolic risk factor) and remain free of cardiometabolic disease (3). Third, BMI has never emerged as a component of the Framingham (4) or Pooled Cohort Equation (5) CVD risk scores, because it does not add sufficient discriminatory capacity over traditional risk factors. Finally, higher-BMI individuals may even demonstrate an "obesity paradox" with lower rates of mortality and morbidity from established CVDs compared with those with normal BMI (6). These important limitations create an opportunity for new adiposity-related biomarkers to emerge that will impact clinical cardiovascular care while improving on the inherent shortcomings of BMI assessment.

http://ift.tt/2dmInLg