Abstract
BackgroundObesity has increased worldwide. Although the visceral-to-subcutaneous fat ratio (VS ratio) is an established risk factor for cardiovascular disease, its clinical impact on the long-term prognosis of patients with acute aortic dissection (AAD) remains unclear.Materials and methodsThis retrospective study included 111 patients with AAD admitted to our hospital from 2013 to 2016. Patients who died during hospitalization, and those diagnosed with Marfan’s syndrome were excluded. Visceral and subcutaneous fat accumulation (VFA, SFA) at umbilical level were calculated on a dedicated workstation. Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) and worsening renal function (WRF) at 3 years were evaluated.ResultsPatient characteristics were as below: age, 73 ± 13; male, 55%; Stanford type A, 53%. Average VFA, SFA, and VS ratio on admission were 98 (52–145) cm2, 141 (90–185) cm2, and 0.75 (0.47–0.97), respectively. VFA was higher in male than in female (male, 134 [84–179] cm2; female, 71 [46–99] cm2; p < 0.001), whereas SFA was similar (male, 141 [91–174] cm2: female, 134 [90–205] cm2; p = 0.687). VS ratio was also higher in male (male, 0.88 [0.75–1.17]; female, 0.49 [0.39–0.65]; p < 0.001). Both MACCE and WRF at 3 years were observed in 17 (15%) and 32 (29%) patients, respectively. Multivariate Cox regression analysis demonstrated that VS ratio tended to be associated with the 3-year MACCE (HR for an increase of 0.5 unit, 1.49; 95% CI, 0.99–2.24; p = 0.056). This result persisted in male (HR for an increase of 0.5 unit, 1.54; 95% CI, 0.96–2.48; p = 0.073) but not female. The VS ratio was not related to the 3-year WRF.ConclusionThe VS ratio tends to be associated with the 3-year MACCE in patients with AAD. This finding is inconclusive owing to a small sample and low incidence of adverse events. Further studies with larger samples are needed to confirm the clinical significance of VS ratio.
Highlights
The increasing prevalence of obesity, which is related to both increased mortality and morbidity [1,2,3], is a major health problem in both developed and developing countries [4,5,6]
Multivariate Cox regression analysis demonstrated that VS ratio tended to be associated with the 3-year Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) (HR for an increase of 0.5 unit, 1.49; 95% confidence interval (CI), 0.99–2.24; p = 0.056)
This result persisted in male (HR for an increase of 0.5 unit, 1.54; 95% CI, 0.96–2.48; p = 0.073) but not female
Summary
The increasing prevalence of obesity, which is related to both increased mortality and morbidity [1,2,3], is a major health problem in both developed and developing countries [4,5,6]. Patients with abdominal aortic aneurysms have similar VFA and a higher VS ratio compared to those without [17], but few studies have reported a correlation between AAD and these factors. Previous studies have shown that there are differences in body fat between men and women [22] This heterogeneity may provide a different clinical significance of VFA and the VS ratio for male and female. This study aimed to clarify the characteristics including sex differences and the clinical impact of VFA and the VS ratio in patients with AAD. The visceral-to-subcutaneous fat ratio (VS ratio) is an established risk factor for cardiovascular disease, its clinical impact on the long-term prognosis of patients with acute aortic dissection (AAD) remains unclear
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