Abstract
BackgroundAlthough central fat is a well-known risk factor for cardiovascular disease (CVD) and cardiometabolic disorders, the effect of other regional fats or muscle distribution on CVD risk has not been fully investigated.MethodsThis was a cross-sectional study using nationally representative samples of 15,686 subjects from the 2008–2011 Korea National Health and Nutrition Examination Survey. Individual CVD risk was evaluated in adults aged ≥20 without prior CVD, using atherosclerotic cardiovascular disease (ASCVD) risk equations according to the 2013 ACC/AHA guidelines. Body composition was assessed by dual X-ray absorptiometry.ResultsRatio of leg fat to total fat (LF/TF ratio) was the most predictive for CVD among body fat or muscle distribution parameters (AUC = 0.748, 95% CI 0.741–0.755). ASCVD risk score was gradually increased with decreased LF/TF ratio (P < 0.001), and individuals whose LF/TF ratio in lowest tertile tended to belong to the high-risk (10-year risk >10%) group compared to those in the highest tertile (OR = 6.25, 95% CI 5.60–6.98). Subjects in the lowest tertile showed increased risk of cardiometabolic risk factor components including obesity, hypertension, diabetes, dyslipidemia, chronic kidney disease, and albuminuria (OR range 2.57–11.24, all P < 0.001). In addition, a higher LF/TF ratio was associated with decreased ASCVD risk, even in subjects with multiple CVD risk factors. Multiple logistic regression analyses also demonstrated this association (OR = 1.85, 95% CI 1.36–2.52).ConclusionsAmong various body composition parameters, LF/TF ratio was superior in predicting higher CVD risk and a higher LF/TF ratio was independently associated with decreased risk of CVD and each cardiometabolic risk factor.
Highlights
Central fat is a well-known risk factor for cardiovascular disease (CVD) and cardiometabolic disorders, the effect of other regional fats or muscle distribution on CVD risk has not been fully investigated
The LF/TF ratio (AUC = 0.748, 95% confidence interval (CI) 0.741–0.755) showed greater accuracy in predicting high American College of Cardiology/American Heart Association (ACC/AHA) atherosclerotic cardiovascular disease (ASCVD) risk compared to other fat distributions (AUCarm fat/ total fat ratio = 0.568, 95% CI 0.561–0.576, AUCtrunk fat/ total fat ratio = 0.717, 95% CI 0.709–0.724, A UCwaist circumference = 0.659, 95% CI 0.652–0.667) (Fig. 2b)
After stratifying into sex-specific leg fat and total fat tertile separately, individuals with a higher leg fat even in higher total fat had shown lower ACC/AHA ASCVD risk compared to lower leg fat and lower total fat groups (Fig. 2c)
Summary
Central fat is a well-known risk factor for cardiovascular disease (CVD) and cardiometabolic disorders, the effect of other regional fats or muscle distribution on CVD risk has not been fully investigated. Overweight and obesity are related to cardiovascular, and all-cause mortality [1]. It has been demonstrated that excessive visceral fat is related to an increased risk of hypertension [2] and diabetes [3]. The association between excessive abdominal fat and risk of Visceral adiposity is linked to altered myocardial glucose uptake [4], concentric left ventricular remodeling [5], and left atrial dysfunction [6]. Thigh girth or thigh fat is reported to attenuate risk for dyslipidemia [7] and glucose intolerance [8].
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