Body Mass Index vs Cholesterol in Cardiovascular Disease Risk Prediction Models

Traditional modifiable risk factors for cardiovascular disease (CVD) are smoking, high blood pressure, and unfavorable blood lipid concentrations. Models combining these factors predict CVD more accurately than models considering CVD risk factors in an isolated manner.^1- 3 Combined risk prediction models include the Framingham Risk Score or, from Europe, the SCORE (Systematic Coronary Risk Evaluation).^1- 2 One disadvantage of these assessments is that they require blood sampling for lipid measurements. This precludes the estimation of the 10-year risk of a CVD event, eg, from self-reports. In electronic health records, the lack of information on cholesterol was the most common reason why CVD risk could not be calculated.⁴ In contrast, body height and weight are available in virtually all health data sets. On the basis of the SCORE method and using a population sample from Switzerland, we aimed at comparing the traditional prediction model using total cholesterol with a version in which we replaced cholesterol with body mass index (BMI).¹