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. 2021 Jun;10(11):e019968.
doi: 10.1161/JAHA.120.019968. Epub 2021 May 15.

Sex Differences in the Associations of Visceral Adipose Tissue and Cardiometabolic and Cardiovascular Disease Risk: The Framingham Heart Study

Andreas A Kammerlander  1   2 , Asya Lyass  3 , Taylor F Mahoney  4 , Joseph M Massaro  4 , Michelle T Long  5 , Ramachandran S Vasan  6   7   8 , Udo Hoffmann  1
Affiliations

Sex Differences in the Associations of Visceral Adipose Tissue and Cardiometabolic and Cardiovascular Disease Risk: The Framingham Heart Study

Andreas A Kammerlander et al. J Am Heart Assoc. 2021 Jun.

Abstract

Background Men and women are labeled as obese on the basis of a body mass index (BMI) using the same criterion despite known differences in their fat distributions. Subcutaneous adipose tissue and visceral adipose tissue (VAT), as measured by computed tomography, are advanced measures of obesity that closely correlate with cardiometabolic risk independent of BMI. However, it remains unknown whether prognostic significance of anthropometric measures of adiposity versus VAT varies in men versus women. Methods and Results In 3482 FHS (Framingham Heart Study) participants (48.1% women; mean age, 50.8±10.3 years), we tested the associations of computed tomography-based versus anthropometric measures of fat with cardiometabolic and cardiovascular disease (CVD) risk. Mean follow-up was 12.7±2.1 years. In men, VAT, as compared with BMI, had a similar strength of association with incident cardiometabolic risk factors (eg, adjusted odds ratio [OR], 2.36 [95% CI, 1.84-3.04] versus 2.66 [95% CI, 2.04-3.47] for diabetes mellitus) and CVD events (eg, adjusted hazard ratio [HR], 1.32 [95% CI, 0.97-1.80] versus 1.74 [95% CI, 1.14-2.65] for CVD death). In women, however, VAT, when compared with BMI, conferred a markedly greater association with incident cardiometabolic risk factors (eg, adjusted OR, 4.51 [95% CI, 3.13-6.50] versus 2.33 [95% CI, 1.88-3.04] for diabetes mellitus) as well as CVD events (eg, adjusted HR, 1.85 [95% CI, 1.26-2.71] versus 1.19 [95% CI, 1.01-1.40] for CVD death). Conclusions Anthropometric measures of obesity, including waist circumference and BMI, adequately capture VAT-associated cardiometabolic and cardiovascular risk in men but not in women. In women, abdominal computed tomography-based VAT measures permit more precise assessment of obesity-associated cardiometabolic and cardiovascular risk.

Keywords: body mass index; cardiovascular risk; metabolic health; obesity; sex differences; visceral adipose tissue.

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Conflict of interest statement

Dr Kammerlander reports receiving a grant from the Austrian Society of Cardiology during the time of this work. Dr Vasan is supported in part by the Evans Medical Foundation and the Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine. Dr Long is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases K23 DK113252, the Doris Duke Charitable Foundation, Gilead Sciences Research Scholars Award, the Boston University School of Medicine Department of Medicine Career Investment Award, and the Boston University Clinical Translational Science Institute UL1 TR001430. Dr Long reports consulting fees for Iterative Scopes and Ionis Pharmaceuticals and research funding from Gilead Sciences and Echosens Corporation, all not related to the present research. Dr Hoffmann reports research support not related to the present research: research grants on behalf of the institution: KOWA, MedImmune, HeartFlow, Duke University, Oregon Health & Science University (American Heart Association, 13FTF16450001), Columbia University (National Institutes of Health [NIH], 5R01‐HL109711), NIH/National Heart, Lung, and Blood Institute (NHLBI) 5K24HL113128, NIH/NHLBI 5T32HL076136, NIH/NHLBI 5U01HL123339; and consulting fees: Duke University and Recor Medical. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Sex‐specific association of anthropometric and computer tomography–derived measures of obesity with prevalent metabolic health status.
A, Sex‐specific association of body mass index (BMI), waist circumference (WC), and visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio on computed tomography with prevalence of being metabolically unhealthy. Analyses are adjusted (Adj.) for age and smoking, and odds ratios (ORs) are given per 1‐SD increase of each measure of fat. B, The different strengths of association for BMI (gray) and VAT (black) with prevalence of being metabolically unhealthy are displayed for men and women separately.
Figure 2
Figure 2. Sex‐specific association of anthropometric and computer tomography–derived measures of obesity with becoming metabolically unhealthy.
A, Sex‐specific adjusted odds ratios (Adj. ORs) demonstrating the different strengths of association for body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) with becoming metabolically unhealthy. B, The different strengths of association for BMI (gray) and VAT (black) with becoming metabolically unhealthy are displayed for men and women separately.
Figure 3
Figure 3. Sex‐specific association of anthropometric and computer tomography–derived measures of obesity with incident cardiometabolic risk factors.
A, Sex‐specific association of body mass index (BMI), waist circumference (WC), and visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio on computed tomography with incident cardiometabolic risk factors. Analyses are adjusted (Adj.) for age and smoking, and odds ratios (ORs) are given per 1‐SD increase of each measure of fat. B, The different strengths of association for BMI (gray) and VAT (black) with incident cardiometabolic risk factors are displayed for men and women separately. HDL indicates high‐density lipoprotein.
Figure 4
Figure 4. Sex‐specific differences of body mass index and visceral adipose tissue with incident cardiovascular disease (CVD) events.
The different strengths of association for body mass index (BMI; gray) and visceral adipose tissue (VAT; black) with incident cardiovascular events are displayed for men and women separately. Adj. HR indicates adjusted hazard ratio; and CV, cardiovascular.
See this image and copyright information in PMC

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