Visceral adipose tissue and hepatic fat as determinants of carotid atherosclerosis

Visceral adipose tissue (VAT) and hepatic fat (HF) contribute to multiple health risks, including diabetes, hypertension, cardiovascular disease, cognitive decline, and cancer. The objective of this study is to determine whether VAT and HF are associated with carotid atherosclerosis beyond traditional cardiovascular risk factors.

Participants in the Canadian Alliance of Healthy Hearts and Minds (CAHHM) cohort study (n = 6760; average age= 57.1; 54.9% female) underwent MRI for VAT volume, hepatic fat fraction (HFF), and carotid atherosclerosis assessed by carotid wall volume (CWV). Regression models were used to assess the associations of VAT and HF with carotid atherosclerosis, separately in males and females, controlling for other cardiovascular risk factors. Associations of VAT and proton-density hepatic fat fraction (PDFF) with ultrasound-measured carotid-intima media thickness (CIMT) were also assessed in the UK Biobank (UKB; n = 26,547; average age = 54.7; 51.9% female).

In CAHHM, we show that a 1-SD higher VAT volume is associated with a 6.16 mm³ higher CWV (95% CI: 1.68 to 10.63), but there is no association between HFF and CWV. In the UK Biobank cohort, a 1-SD higher VAT volume is associated with a 0.016 ± 0.009 mm higher CIMT, and a 1-SD higher PDFF is associated with a 0.012 ± 0.010 mm higher CIMT. After adjustment for CV risk factors, these associations are attenuated. A pooled analyses of CAHHM and UKB support a direct, positive association of VAT and HFF with subclinical atherosclerosis in both sexes, albeit slightly weaker for hepatic fat.

Visceral fat, and to a lesser extent, hepatic fat, are associated with increased carotid atherosclerosis.