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Association Between Abdominal Fat and Mortality in Patients Undergoing Cardiovascular Surgery
Jinyoung Bae1, Jae-Woo Ju1, Seohee Lee1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Insights
Reduced abdominal subcutaneous fat is linked to increased mortality after cardiovascular surgery in East Asian patients. This finding highlights the importance of fat composition over general obesity metrics for predicting surgical outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Obesity Research
Background:
- Obesity is paradoxically linked to lower mortality after cardiovascular surgery.
- Body mass index (BMI) does not distinguish between fat types, limiting its predictive power.
- Abdominal fat composition (total, subcutaneous, visceral) may offer better insights into surgical outcomes.
Purpose of the Study:
- To investigate the association between abdominal fat composition and postoperative mortality.
- To differentiate the roles of total, subcutaneous, and visceral fat in cardiovascular surgery outcomes.
- To analyze these relationships in an East Asian patient cohort.
Main Methods:
- Retrospective analysis of adult patients undergoing cardiovascular surgery (Oct 2004 - Dec 2016).
- Measurement of total, subcutaneous, and visceral fat areas using computed tomography (CT) scans.
- Statistical evaluation of the relationship between fat areas and all-cause/cardiac mortality.
Main Results:
- Analysis included 3661 patients with an overall mortality of 19.9% over 4.6 years.
- Increased subcutaneous fat area was associated with decreased all-cause and cardiac mortality (aHR 0.997 and 0.994, respectively).
- No significant association was found between total or visceral fat area and mortality.
Conclusions:
- Lower abdominal subcutaneous fat is an independent risk factor for mortality post-cardiovascular surgery.
- Fat composition, specifically subcutaneous fat, is a more relevant predictor than general obesity or visceral fat.
- Findings are particularly relevant for East Asian populations, often normal or overweight.
Background:
Obesity is associated with reduced postoperative mortality among patients undergoing cardiovascular surgery. However, body mass index cannot differentiate abdominal fat composition. This study evaluated the relationships between total abdominal, subcutaneous, and visceral fat composition and postoperative mortality in East Asian patients undergoing cardiovascular surgery.
Methods:
Adult patients who underwent cardiovascular surgery between October 2004 and December 2016 were retrospectively included. Total, subcutaneous, and visceral fat areas were measured from cross-sectional computed tomography images. The relationships between each fat composition and mortality were evaluated.
Results:
In all, 3661 patients were analyzed, and overall mortality was 19.9% (729 died) during the 4.6-year median follow-up period. The risks of all-cause and cardiac-cause mortality decreased as subcutaneous fat composition increased (adjusted hazard ratio 0.997; 95% confidence interval, 0.994 to 1.000; and adjusted hazard ratio 0.994; 95% confidence interval, 0.989 to 0.999; P = .02 and P = .01, respectively). No association was detected between the total and visceral fat area and mortality.
Conclusions:
Reduced abdominal subcutaneous fat, but not the total or visceral fat composition, was associated with higher all-cause and cardiac-cause mortality after cardiovascular surgery in East Asian patients, consisting mainly of normal weight or overweight patients.
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