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Sex differences in the relationship between body composition and cardiac structure and function.

Heidi S Hartman1, Eunyoung Kim1, Salvatore Carbone2

  • 1Division of Cardiology, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, USA.

European Heart Journal. Cardiovascular Imaging
|October 14, 2024
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Summary

Visceral adipose tissue and muscle fat infiltration are linked to increased heart mass in women, but not men. Lean mass impacts heart size in both sexes. Insulin resistance may mediate fat-related heart changes.

Keywords:
cardiac magnetic resonancelean body massleft ventricular functionleft ventricular geometryvisceral adiposity

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Area of Science:

  • Cardiology
  • Endocrinology
  • Biomedical Engineering

Background:

  • Body composition significantly influences cardiovascular health.
  • Sex-specific differences in body composition and cardiac parameters are increasingly recognized.
  • Understanding these sex differences is crucial for targeted cardiovascular disease prevention and treatment.

Purpose of the Study:

  • To investigate sex differences in the associations between body composition metrics and cardiac structure/function.
  • To explore potential pathophysiologic mediators, such as insulin resistance, linking body composition to cardiac parameters.

Main Methods:

  • Cross-sectional analysis of 25,063 UK Biobank participants.
  • Linear regression models to assess associations between visceral adipose tissue volume (VAT), appendicular lean mass (ALM), and muscle fat infiltration (MFI) with cardiac magnetic resonance (CMR) measures.
  • Causal mediation analysis to identify biomarkers mediating the relationship between adipose depots and cardiac parameters.

Main Results:

  • Visceral adipose tissue (VAT) was associated with increased left ventricular mass (LVM) and wall thickness in women, but not men.
  • Muscle fat infiltration (MFI) showed similar sex-specific associations with LVM, significant in women only.
  • Appendicular lean mass (ALM) was associated with increased LVM and left ventricular volumes in both sexes.
  • Insulin resistance (triglycerides/high-density lipoprotein ratio) partially mediated the effect of VAT on cardiac chamber dimensions.

Conclusions:

  • Visceral adipose tissue (VAT) and muscle fat infiltration (MFI) are linked to adverse cardiac remodeling (increased LVM, wall thickness) in women, but not men.
  • Appendicular lean mass (ALM) demonstrates a positive association with cardiac structure in both sexes.
  • These findings highlight significant sex differences in how body composition affects the heart, with implications for cardiovascular risk assessment and management.