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CT-Derived Body Fat Distribution and Incident Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Morgana Mongraw-Chaffin1,2, Matthew A Allison3, Gregory L Burke4
1Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157.
Insights
Visceral fat, unlike subcutaneous fat, is linked to higher cardiovascular disease (CVD) risk. Reducing visceral fat through lifestyle changes is crucial for preventing heart disease and improving health outcomes.
Area of Science:
- Cardiology
- Metabolic Health
- Public Health
Background:
- Visceral fat accumulation is linked to cardiometabolic risk, but its independent association with cardiovascular disease (CVD) and mortality is not well-established, especially in diverse populations.
- Subcutaneous fat's role in these outcomes remains unclear.
- Limited evidence exists from multi-ethnic cohorts regarding the differential impact of visceral versus subcutaneous fat.
Purpose of the Study:
- To investigate the independent associations of visceral and subcutaneous abdominal fat with incident cardiovascular disease (CVD) and all-cause mortality.
- To examine these relationships in a diverse, multi-ethnic cohort.
- To determine if visceral fat, but not subcutaneous fat, is independently associated with adverse health outcomes.
Main Methods:
- Utilized computed tomography scans for abdominal fat quantification in 1910 participants from the Multi-Ethnic Study of Atherosclerosis.
- Employed multivariable Cox proportional hazards models to analyze the relationship between visceral and subcutaneous fat tertiles and outcomes.
- Followed participants for an average of 9.3 years, assessing incident CVD and all-cause mortality, with sensitivity analyses performed.
Main Results:
- Higher tertiles of visceral fat were significantly associated with increased risk of CVD, particularly coronary heart disease (HR for tertile 3: 3.00).
- No substantial associations were found between subcutaneous fat levels and incident CVD or all-cause mortality.
- These associations remained significant after adjusting for numerous confounders, including subcutaneous fat, and showed no significant interactions by age, sex, or race/ethnicity.
Conclusions:
- Visceral fat, independently of subcutaneous fat, is a significant predictor of increased cardiovascular disease risk in a multi-ethnic population.
- Subcutaneous fat does not appear to be substantially associated with CVD or mortality risk.
- Findings underscore the importance of targeting visceral fat reduction through lifestyle interventions to mitigate cardiovascular risk.
Background:
Visceral fat has been shown to be associated with increased cardiometabolic risk, but the role of subcutaneous fat remains unclear, and evidence from diverse populations is lacking. We hypothesized that visceral fat, but not subcutaneous fat, would be independently associated with incident cardiovascular disease (CVD) and all-cause mortality.
Methods:
Among 1910 participants from the Multi-Ethnic Study of Atherosclerosis with abdominal fat measurements from computed tomography scans and followed for an average of 9.3 years, we used multivariable Cox proportional hazards models to investigate the relationship of both visceral and subcutaneous fat tertiles with CVD and all-cause mortality. We tested for interaction and performed sensitivity analysis for subgroups and missing values of visceral fat.
Results:
Participants had mean age of 65 years, visceral fat 150 cm2, subcutaneous fat 263 cm2, and 50% were female, 21% African American, 13% Asian, and 26% Hispanic. In models adjusted for age, sex, race/ethnicity, income, education, smoking, and subcutaneous fat, there was a statistically significant positive association between visceral fat and CVD, but not mortality. The association for combined CVD may be driven by incident coronary heart disease [tertile 2: hazard ratio, 2.43 (1.38 to 4.28); tertile 3: hazard ratio, 3.00 (1.66 to 5.43)]. Additionally, we found no substantial associations between subcutaneous fat and CVD or mortality. There were no statistically significant interactions by age, sex, or race/ethnicity.
Conclusions:
Visceral fat, but not subcutaneous fat, is significantly associated with increased risk for CVD in a multiethnic cohort. These data support the need for effective strategies for lifestyle changes that prevent and reduce visceral fat.
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