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Regional Adiposity and Risk of Heart Failure and Mortality: The Jackson Heart Study
Vishal N Rao1,2, Christopher G Bush1,3, Morgana Mongraw-Chaffin4
1Duke Clinical Research Institute Duke University School of Medicine Durham NC.
Insights
Pericardial and visceral adipose tissue (VAT) increase heart failure (HF) risk in Black individuals, while subcutaneous adipose tissue (SAT) does not. High pericardial adipose tissue (PAT) is also linked to increased mortality risk.
Area of Science:
- Cardiology
- Public Health
- Medical Imaging
Background:
- Visceral adipose tissue (VAT) is linked to heart failure (HF) and HF with preserved ejection fraction (HFpEF).
- The impact of pericardial adipose tissue (PAT) and abdominal adiposity on HF and mortality risks in Black individuals remains unclear.
- This study investigates the associations of PAT, VAT, and subcutaneous adipose tissue (SAT) with HF hospitalization and all-cause mortality in a Black community cohort.
Purpose of the Study:
- To examine the associations between pericardial, visceral, and subcutaneous adipose tissue and incident HF hospitalization.
- To assess the relationship between these adipose tissue depots and all-cause mortality in Black participants.
- To determine if regional adiposity influences HF and mortality risk predictions.
Main Methods:
- Utilized data from 2882 Black participants in the Jackson Heart Study Exam 2 without prevalent HF.
- Employed computed tomography (CT) to quantify pericardial adipose tissue (PAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT).
- Applied Cox proportional hazards models, adjusting for demographics and cardiovascular risk factors, to analyze associations with incident HF and mortality over a median follow-up of 10.6 years.
Main Results:
- Higher PAT and VAT were significantly associated with increased risk of incident HF hospitalization.
- Both PAT and VAT were associated with a higher risk of HF with preserved ejection fraction (HFpEF).
- Increased PAT was associated with higher all-cause mortality risk, whereas VAT and SAT showed no significant association with mortality.
Conclusions:
- Pericardial adipose tissue (PAT) and visceral adipose tissue (VAT), but not subcutaneous adipose tissue (SAT), are independently associated with increased risk of heart failure (HF) and HF with preserved ejection fraction (HFpEF) in Black individuals.
- High PAT is also associated with increased all-cause mortality in this population.
- Further research is needed to explore if interventions targeting regional adiposity can improve HF risk prediction, particularly for HFpEF.
Abstract:
Background Visceral adipose tissue (VAT) is associated with incident heart failure (HF) and HF with preserved ejection fraction, yet it is unknown how pericardial and abdominal adiposity affect HF and mortality risks in Black individuals. We examined the associations of pericardial adipose tissue (PAT), VAT, and subcutaneous adipose tissue (SAT) with incident HF hospitalization and all-cause mortality in a large community cohort of Black participants. Methods and Results Among the 2882 Jackson Heart Study Exam 2 participants without prevalent HF who underwent body computed tomography, we used Cox proportional hazards models to examine associations between computed tomography-derived regional adiposity and incident HF hospitalization and all-cause mortality. Fully adjusted models included demographics and cardiovascular disease risk factors. Median follow-up was 10.6 years among participants with available VAT (n=2844), SAT (n=2843), and PAT (n=1386). Fully adjusted hazard ratios (95% CIs) of distinct computed tomography-derived adiposity measures (PAT per 10 cm3, VAT or SAT per 100 cm3) were as follows: for incident HF, PAT 1.08 (95% CI, 1.02-1.14) and VAT 1.04 (95% CI, 1.01-1.08); for HF with preserved ejection fraction, PAT 1.13 (95% CI, 1.04-1.21) and VAT 1.07 (95% CI, 1.01-1.13); for mortality, PAT 1.07 (95% CI, 1.03-1.12) and VAT 1.01 (95% CI, 0.98-1.04). SAT was not associated with either outcome. Conclusions High PAT and VAT, but not SAT, were associated with incident HF and HF with preserved ejection fraction, and only PAT was associated with mortality in the fully adjusted models in a longitudinal community cohort of Black participants. Future studies may help understand whether changes in regional adiposity improves HF, particularly HF with preserved ejection fraction, risk predictions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005485.
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