Visceral adipose tissue and hepatic fat as determinants of carotid atherosclerosis

Russell J de Souza^{1

2

3}, Marie E Pigeyre^{2

4

5}, Karleen M Schulze^{2

4}, Amel Lamri^{2

4}, Baraa K Al-Khazraji⁶, Philip Awadalla^{7

8

9}, Joseph Beyene¹, Dipika Desai^{1

2}, Jean-Pierre Despres^{10

11

12}, Trevor J B Dummer¹³, Matthias G Friedrich^{14

15}, Jason Hicks¹⁶, Vikki Ho^{17

18}, Éric LaRose¹⁰, Scott A Lear¹⁹, Douglas S Lee^{20

21}, Jonathon A Leipsic²², Guillaume Lettre^{23

24}, Alan R Moody²⁵, Michael D Noseworthy^{26

27

28

29}, Guillaume Pare^{1

2

3

4

5

30}, Grace Parraga^{31

32}, Paul Poirier^{10

33}, Jean-Claude Tardif^{23

24}, Salim Yusuf^{2

4}, Jennifer Vena³⁴, Sonia S Anand^{35

36

37

38}

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
² Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada.
³ Mary Heersink School of Global Health and Social Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁵ Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada.
⁶ Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada.
⁷ Ontario Institute for Cancer Research, Toronto, ON, Canada.
⁸ Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
⁹ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada.
¹¹ Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada.
¹² VITAM-Centre de Recherche en Santé Durable, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.
¹³ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
¹⁴ Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC, Canada.
¹⁵ Courtois Cardiovascular Signature Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
¹⁶ Atlantic PATH, Dalhousie University, Halifax, NS, Canada.
¹⁷ Université de Montréal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
¹⁸ Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
¹⁹ Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
²⁰ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
²¹ Peter Munk Cardiac Centre University Health Network University of Toronto, Toronto, ON, Canada.
²² Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
²³ Montreal Heart Institute, Montréal, QC, Canada.
²⁴ Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
²⁵ Sunnybrook Health Science Centre, Toronto, ON, Canada.
²⁶ Imaging Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada.
²⁷ Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON, Canada.
²⁸ McMaster School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
²⁹ Department of Medical Imaging, McMaster University, Hamilton, ON, Canada.
³⁰ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
³¹ Robarts Research Institute, The University of Western Ontario, London, ON, Canada.
³² Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.
³³ Faculty of Pharmacy, Université Laval, Québec, QC, Canada.
³⁴ Alberta's Tomorrow Project, Alberta Health Services, Calgary, AB, Canada.
³⁵ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca.
³⁶ Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada. anands@mcmaster.ca.
³⁷ Mary Heersink School of Global Health and Social Medicine, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca.
³⁸ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca.

PMID: 41107464
PMCID: PMC12534607
DOI: 10.1038/s43856-025-01123-y

Visceral adipose tissue and hepatic fat as determinants of carotid atherosclerosis

Russell J de Souza et al. Commun Med (Lond). 2025.

. 2025 Oct 17;5(1):424.

doi: 10.1038/s43856-025-01123-y.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
² Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada.
³ Mary Heersink School of Global Health and Social Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁵ Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada.
⁶ Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada.
⁷ Ontario Institute for Cancer Research, Toronto, ON, Canada.
⁸ Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
⁹ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada.
¹¹ Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada.
¹² VITAM-Centre de Recherche en Santé Durable, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.
¹³ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
¹⁴ Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC, Canada.
¹⁵ Courtois Cardiovascular Signature Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
¹⁶ Atlantic PATH, Dalhousie University, Halifax, NS, Canada.
¹⁷ Université de Montréal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
¹⁸ Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
¹⁹ Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
²⁰ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
²¹ Peter Munk Cardiac Centre University Health Network University of Toronto, Toronto, ON, Canada.
²² Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
²³ Montreal Heart Institute, Montréal, QC, Canada.
²⁴ Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
²⁵ Sunnybrook Health Science Centre, Toronto, ON, Canada.
²⁶ Imaging Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada.
²⁷ Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON, Canada.
²⁸ McMaster School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
²⁹ Department of Medical Imaging, McMaster University, Hamilton, ON, Canada.
³⁰ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
³¹ Robarts Research Institute, The University of Western Ontario, London, ON, Canada.
³² Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.
³³ Faculty of Pharmacy, Université Laval, Québec, QC, Canada.
³⁴ Alberta's Tomorrow Project, Alberta Health Services, Calgary, AB, Canada.
³⁵ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca.
³⁶ Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada. anands@mcmaster.ca.
³⁷ Mary Heersink School of Global Health and Social Medicine, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca.
³⁸ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca.

PMID: 41107464
PMCID: PMC12534607
DOI: 10.1038/s43856-025-01123-y

Abstract

Background: 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.

Methods: 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).

Results: 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.

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

Plain language summary

Visceral fat, a type of fat stored in the abdomen, and buildup of fat within the liver are known to increase type 2 diabetes, high blood pressure, and heart disease risk. This study aims to see how these types of fat affect artery health. We studied 6760 Canadian adults to examine how visceral and liver fat relate to the buildup of fatty plaque deposits in arteries, and 26,547 adults from the United Kingdom to see how these fats affect artery thickness. Combined results confirm that narrowed arteries and plaque buildup are strongly related to visceral fat, and to a lesser extent liver fat. These results suggest that lowering visceral fat may prevent or slow the progression of atherosclerosis.

PubMed Disclaimer

Figures

**Fig. 1. Schematic overview of carotid intima-media thickness (cIMT) measurement using ultrasound (top) and carotid wall volume (CWV) measurement using magnetic resonance imaging (MRI; bottom).**
Anatomical landmarks include the common carotid artery, bifurcation, and internal/external branches. Insets illustrate the vessel wall layers evaluated by each modality.

**Fig. 2. Forest plot of pooled (CAHHM with UKB) associations of measures of visceral and hepatic fat with atherosclerosis (standardized means).**
Squares represent point estimates, and horizontal lines are the bounds of the 95% CI. STM, standardized mean. A value of 0 is interpreted as 1 standard unit of atherosclerosis measure, calculated for each individual as $\frac{x - \bar{x}}{S D}$ , where x = individual CIMT or CWV measure, $\bar{x}$ = cohort and sex-specific mean CIMT or CWV measure, and SD = cohort and sex-specific SD of CIMT or CWV measure. CAHHM models adjusted for: age, ethnicity, IHRS, VAT (for HFF) or HFF (for VAT). UKB models adjusted for age, ethnicity, smoking, alcohol, hypertension, diabetes, dyslipidemia, WHR, and VAT (for PDFF) or PDFF (for VAT). P-trend for pooled data assessed using variance-weighted least squares (n= 32, 185 for visceral fat; n= 32, 185 for hepatic fat).

See this image and copyright information in PMC

References

1. World Health Organization. Obesity and Overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (2024).
1. World Health Organization. Obesity. https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity (2021).
1. Laine, C. & Wee, C. C. Overweight and obesity: current clinical challenges. Ann. Intern. Med. 176, 699–700 (2023). - PubMed
1. Laine, C. & Wee, C. C. Correction: overweight and obesity: current clinical challenges. Ann. Intern. Med. 176, 1016 (2023). - PubMed
1. Peters, S. A. E., Bots, S. H. & Woodward, M. Sex Differences in the association between measures of general and central adiposity and the risk of myocardial infarction: results from the UK Biobank. J. Am. Heart Assoc.7, e008507 (2018). - PMC - PubMed

LinkOut - more resources

Full Text Sources
- Nature Publishing Group
- PubMed Central
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Visceral adipose tissue and hepatic fat as determinants of carotid atherosclerosis

Affiliations

Visceral adipose tissue and hepatic fat as determinants of carotid atherosclerosis

Authors

Affiliations

Abstract

Plain language summary

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous