Impact of body mass index and waist circumference on the cardiovascular risk and all-cause death in a general population: Data from the PAMELA study

Background and aims: Elevated values of body mass index (BMI) and waist circumference (WC) are associated with an augmented cardiovascular (CV) risk. It is debated, however, whether and to what extent this depends on the body fat increase '. per se' or on the related cardiometabolic alterations. Methods and results: In 2005 subjects randomly selected from the general population of Monza (Italy), we assessed BMI, WC, office, home and 24h blood pressure (BP), heart rate and metabolic variables. The impact of BMI and WC on the incidence of CV events, CV and all-cause mortality was estimated during a 148-month follow-up. Progressively higher values of BMI and WC were associated with a progressive increase in office, home and 24h BP and in erratic BP variability (P-2 and 1cm were associated with an increased risk of CV events, CV and all-cause death by 8%, 12% and 7% (for baseline BMI) and 4%, 5% and 4% (for baseline WC), respectively. After adjustment for confounders, only the increased risk of CV death related to higher baseline BMI remained significant (hazard ratio (HR) 1.062, confidence interval (CI) 95% 1.003-1.126, P