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. 2019 Sep 7;40(34):2849-2855.
doi: 10.1093/eurheartj/ehz391.

Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index

Guo-Chong Chen  1 , Rhonda Arthur  1 , Neil M Iyengar  2   3 , Victor Kamensky  1 , Xiaonan Xue  1 , Sylvia Wassertheil-Smoller  1 , Matthew A Allison  4 , Aladdin H Shadyab  4 , Robert A Wild  5 , Yangbo Sun  6 , Hailey R Banack  7 , Jin Choul Chai  1 , Jean Wactawski-Wende  7   8 , JoAnn E Manson  9 , Marcia L Stefanick  10 , Andrew J Dannenberg  3 , Thomas E Rohan  1 , Qibin Qi  1
Affiliations

Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index

Guo-Chong Chen et al. Eur Heart J. .

Abstract

Aims: Central adiposity is associated with increased cardiovascular disease (CVD) risk, even among people with normal body mass index (BMI). We tested the hypothesis that regional body fat deposits (trunk or leg fat) are associated with altered risk of CVD among postmenopausal women with normal BMI.

Methods and results: We included 2683 postmenopausal women with normal BMI (18.5 to <25 kg/m2) who participated in the Women's Health Initiative and had no known CVD at baseline. Body composition was determined by dual energy X-ray absorptiometry. Incident CVD events including coronary heart disease and stroke were ascertained through February 2017. During a median 17.9 years of follow-up, 291 incident CVD cases occurred. After adjustment for demographic, lifestyle, and clinical risk factors, neither whole-body fat mass nor fat percentage was associated with CVD risk. Higher percent trunk fat was associated with increased risk of CVD [highest vs. lowest quartile hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.33-2.74; P-trend <0.001], whereas higher percent leg fat was associated with decreased risk of CVD (highest vs. lowest quartile HR = 0.62, 95% CI 0.43-0.89; P-trend = 0.008). The association for trunk fat was attenuated yet remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher percent trunk fat combined with lower percent leg fat was associated with particularly high risk of CVD (HR comparing extreme groups = 3.33, 95% CI 1.46-7.62).

Conclusion: Among postmenopausal women with normal BMI, both elevated trunk fat and reduced leg fat are associated with increased risk of CVD.

Keywords: Body fat; Cardiovascular disease; Metabolically unhealthy normal weight; Normal-weight obesity; Postmenopausal.

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Figures

Figure 1
Figure 1
Correlations between body fat, lean mass, and anthropometric measures. Results are partial Pearson correlation coefficients adjusted for age and race/ethnicity. BMI, body mass index; FM, fat mass; HC, hip circumference; LM, lean mass; WC, waist circumference; WHR, waist-to-hip ratio.
Figure 2
Figure 2
Association of trunk or leg fat percentage with risk of cardiovascular disease. Results were adjusted for covariates listed for Model 2 in Table 1 and additionally adjusted for other anthropometric measures. BMI, body mass index; CI, confidence interval; HC, hip circumference; HR, hazard ratio; WC, waist circumference; WHR, waist-to-hip ratio.
Figure 3
Figure 3
Joint association of trunk and leg fat percentages with risk of cardiovascular disease. Results were adjusted for covariates listed for Model 2 in Table 1. There was no significant interaction between trunk and leg fat percentages on cardiovascular disease risk (P-interaction = 0.57). CI, confidence interval; HR, hazard ratio.
Take home figure
Take home figure
Among postmenopausal with normal body mass index, higher trunk fat is associated with increased risk of cardiovascular disease, whereas higher leg fat is associated with decreased risk of cardiovascular disease.
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