Association of Visceral Adipose Tissue With Incident Myocardial Infarction in Older Men and Women: The Health, Aging and Body Composition Study

Abstract

Relatively strong associations have been found between risk factors for coronary heart disease and the amount of adipose tissue, measured directly in and around the visceral organs. This prospective study used several measures of adiposity, including total adiposity (body mass index [BMI] and fat mass), body fat distribution, and visceral adipose tissue relative to subcutaneous fat and total fat mass, to analyze the risk of incident myocardial infarction (MI). Subjects were 1116 men and 1387 women 70 to 79 years of age who were enrolled in the Health, Aging and Body Composition Study. MI events totalled 116 during an average follow up of 4.6 years; 40% of them proved fatal. Patients were assessed at 6-month intervals. Total fat mass was estimated by using whole-body dual-energy x-ray absorptiometry and body fat distribution using a computed tomography scanner. Women who had an MI had more visceral adipose tissue at baseline as well as a greater amount of such tissue relative to subcutaneous adipose tissue and to total fat mass compared with other women. No such differences were noted in men. Adjusting for confounding variables, both visceral adipose tissue and visceral adipose tissue/fat mass were significant predictors of MI, but total adiposity did not correlate with incident MI. The hazard ratio was 1.24 for visceral adipose tissue and 1.21 for visceral adipose tissue/fat mass. After stratifying by gender, no connection was found between any adiposity measure and incident MI in men. There was no evident association between the BMI or total fat mass and MI in women. The association with visceral adipose tissue in women was independent of levels of high-density lipoprotein cholesterol and interleukin-6, hypertension, and diabetes. These observations, in accord with those from previous studies, indicate that although the absolute volume of visceral fat may be relatively small, it remains the best obesity-related predictor of MI in elderly women.