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. 2016 Apr;9(4):e004043.
doi: 10.1161/CIRCIMAGING.115.004043.

Relationship Between Measures of Adiposity, Arterial Inflammation, and Subsequent Cardiovascular Events

Amparo L Figueroa  1 , Richard A P Takx  1 , Megan H MacNabb  1 , Amr Abdelbaky  1 , Zachary R Lavender  1 , Rebecca S Kaplan  1 , Quynh A Truong  1 , Janet Lo  1 , Brian B Ghoshhajra  1 , Steven K Grinspoon  1 , Udo Hoffmann  1 , Ahmed Tawakol  2
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Relationship Between Measures of Adiposity, Arterial Inflammation, and Subsequent Cardiovascular Events

Amparo L Figueroa et al. Circ Cardiovasc Imaging. 2016 Apr.

Abstract

Background: The objective of this study was to evaluate how different measures of adiposity are related to both arterial inflammation and the risk of subsequent cardiovascular events.

Methods and results: We included individuals who underwent (18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging for oncological evaluation. Subcutaneous adipose tissue (SAT) volume, visceral adipose tissue (VAT) volume, and VAT/SAT ratio were determined. Additionally, body mass index, metabolic syndrome, and aortic (18)F-fluorodeoxyglucose uptake (a measure of arterial inflammation) were determined. Subsequent development of cardiovascular disease (CVD) events was adjudicated. The analysis included 415 patients with a median age of 55 (P25-P75: 45-65) and a median body mass index of 26.4 (P25-P75: 23.4-30.9) kg/m(2). VAT and SAT volume were significantly higher in obese individuals. VAT volume (r=0.290; P<0.001) and VAT/SAT ratio (r=0.208; P<0.001) were positively correlated with arterial inflammation. Thirty-two subjects experienced a CVD event during a median follow-up of 4 years. Cox proportional hazard models showed that VAT volume and VAT/SAT ratio were associated with CVD events (hazard ratio [95% confidence interval]: 1.15 [1.06-1.25]; P<0.001; 3.60 [1.88-6.92]; P<0.001, respectively). Body mass index, metabolic syndrome, and SAT were not predictive of CVD events.

Conclusions: Measures of visceral fat are positively related to arterial inflammation and are independent predictors of subsequent CVD events. Individuals with higher measures of visceral fat as well as elevated arterial inflammation are at highest risk for subsequent CVD events. The findings suggest that arterial inflammation may explain some of the CVD risk associated with adiposity.

Keywords: adipose tissue; atherosclerosis; cardiovascular events; obesity; positron emission tomography.

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Figures

Figure 1
Figure 1
Flowchart of study design
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve analysis of adiposity measures in predicting CVD events.
Figure 3
Figure 3
KM plot displaying Proportion Free of CVD Events Stratified by (A) BMI (median=26.4 kg/m2), (B) MetS, (C) SAT volume (median=95.0 cm3), (D) VAT volume (median=48.4 cm3), (E) VAT/SAT ratio (median=0.52), and (F) VATAVP (median=31.3).
Figure 3
Figure 3
KM plot displaying Proportion Free of CVD Events Stratified by (A) BMI (median=26.4 kg/m2), (B) MetS, (C) SAT volume (median=95.0 cm3), (D) VAT volume (median=48.4 cm3), (E) VAT/SAT ratio (median=0.52), and (F) VATAVP (median=31.3).
Figure 3
Figure 3
KM plot displaying Proportion Free of CVD Events Stratified by (A) BMI (median=26.4 kg/m2), (B) MetS, (C) SAT volume (median=95.0 cm3), (D) VAT volume (median=48.4 cm3), (E) VAT/SAT ratio (median=0.52), and (F) VATAVP (median=31.3).
Figure 3
Figure 3
KM plot displaying Proportion Free of CVD Events Stratified by (A) BMI (median=26.4 kg/m2), (B) MetS, (C) SAT volume (median=95.0 cm3), (D) VAT volume (median=48.4 cm3), (E) VAT/SAT ratio (median=0.52), and (F) VATAVP (median=31.3).
Figure 3
Figure 3
KM plot displaying Proportion Free of CVD Events Stratified by (A) BMI (median=26.4 kg/m2), (B) MetS, (C) SAT volume (median=95.0 cm3), (D) VAT volume (median=48.4 cm3), (E) VAT/SAT ratio (median=0.52), and (F) VATAVP (median=31.3).
Figure 3
Figure 3
KM plot displaying Proportion Free of CVD Events Stratified by (A) BMI (median=26.4 kg/m2), (B) MetS, (C) SAT volume (median=95.0 cm3), (D) VAT volume (median=48.4 cm3), (E) VAT/SAT ratio (median=0.52), and (F) VATAVP (median=31.3).
Figure 4
Figure 4
KM plot displaying Proportion Free of CVD Events Stratified by the combination of median TBR (median=2.0) and median VAT/SAT ratio (median=0.52). Pairwise log rank comparison showed that only the combination of high VAT/SAT and high aortic TBR was different from the other groups (using low aortic TBR and low VAT/SAT volume as the reference group, p=0.129, p=0.147, p=0.002).
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