Visceral adiposity and subclinical coronary artery disease in elderly adults: Rancho Bernardo Study

Despite growing attention to central obesity as a predictor of clinical coronary heart disease (CHD), there are few reports about the association between directly measured visceral obesity and subclinical coronary atherosclerosis in elderly adults. We examined this association in elderly, community-dwelling adults without clinically recognized CHD.

Elderly adults (190 men, BMI 27.2 +/- 3.6 kg/m(2); 220 women, BMI 25.8 +/- 4.6) aged 55-88 years (median 69 years) with no history of CHD or coronary revascularization had an electron beam computed tomography (EBCT) to measure coronary artery calcification score (CACS), an estimate of coronary plaque burden. Visceral and subcutaneous adiposity were assessed by a triple-slice EBCT scan at the lumbar 4-5 disc level and height, weight, and waist and hip circumferences were measured.

In sex-specific ordinal logistic regression analyses, no measure of obesity or body fat distribution, including BMI, waist-to-hip ratio, waist girth, and visceral and subcutaneous fat by EBCT, was significantly associated with CACS before or after adjusting for multiple covariates of CACS (age, smoking, alcohol intake, exercise, pulse pressure, low-density lipoprotein (LDL)/high-density lipoprotein (HDL)-cholesterol ratio, and fasting plasma glucose).

In elderly adults without clinically recognized CHD, body weight and fat distribution do not predict coronary artery plaque burden. These results raise questions about the value of weight reduction diets for preventing heart disease in elderly survivors without clinical heart disease.