Guo-Chong Chen1, Rhonda Arthur1, Neil M Iyengar2,3, Victor Kamensky1, Xiaonan Xue1, Sylvia Wassertheil-Smoller1, Matthew A Allison4, Aladdin H Shadyab4, Robert A Wild5, Yangbo Sun6, Hailey R Banack7, Jin Choul Chai1, Jean Wactawski-Wende7,8, JoAnn E Manson9, Marcia L Stefanick10, Andrew J Dannenberg3, Thomas E Rohan1, Qibin Qi1. 1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA. 2. Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA. 3. Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, USA. 4. Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, USA. 5. Departments of Obstetrics and Gynecology, Biostatistics and Clinical Epidemiology, Oklahoma University Health Sciences Center, 2466 AAT 800 SLYoung Blvd, Oklahoma City, OK, USA. 6. Department of Epidemiology, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa, IA, USA. 7. Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, 401 Kimball Tower Buffalo, NY, USA. 8. Department of Gynecology-Obstetrics, University at Buffalo, State University of New York at Buffalo, 955 Main Street, Buffalo, NY, USA. 9. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA. 10. Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, USA.
Abstract
AIMS: Central adiposity is associated with increased cardiovascular disease (CVD) risk, even among people with normal body mass index (BMI). We tested the hypothesis that regional body fat deposits (trunk or leg fat) are associated with altered risk of CVD among postmenopausal women with normal BMI. METHODS AND RESULTS: We included 2683 postmenopausal women with normal BMI (18.5 to <25 kg/m2) who participated in the Women's Health Initiative and had no known CVD at baseline. Body composition was determined by dual energy X-ray absorptiometry. Incident CVD events including coronary heart disease and stroke were ascertained through February 2017. During a median 17.9 years of follow-up, 291 incident CVD cases occurred. After adjustment for demographic, lifestyle, and clinical risk factors, neither whole-body fat mass nor fat percentage was associated with CVD risk. Higher percent trunk fat was associated with increased risk of CVD [highest vs. lowest quartile hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.33-2.74; P-trend <0.001], whereas higher percent leg fat was associated with decreased risk of CVD (highest vs. lowest quartile HR = 0.62, 95% CI 0.43-0.89; P-trend = 0.008). The association for trunk fat was attenuated yet remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher percent trunk fat combined with lower percent leg fat was associated with particularly high risk of CVD (HR comparing extreme groups = 3.33, 95% CI 1.46-7.62). CONCLUSION: Among postmenopausal women with normal BMI, both elevated trunk fat and reduced leg fat are associated with increased risk of CVD. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Central adiposity is associated with increased cardiovascular disease (CVD) risk, even among people with normal body mass index (BMI). We tested the hypothesis that regional body fat deposits (trunk or leg fat) are associated with altered risk of CVD among postmenopausal women with normal BMI. METHODS AND RESULTS: We included 2683 postmenopausal women with normal BMI (18.5 to <25 kg/m2) who participated in the Women's Health Initiative and had no known CVD at baseline. Body composition was determined by dual energy X-ray absorptiometry. Incident CVD events including coronary heart disease and stroke were ascertained through February 2017. During a median 17.9 years of follow-up, 291 incident CVD cases occurred. After adjustment for demographic, lifestyle, and clinical risk factors, neither whole-body fat mass nor fat percentage was associated with CVD risk. Higher percent trunk fat was associated with increased risk of CVD [highest vs. lowest quartile hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.33-2.74; P-trend <0.001], whereas higher percent leg fat was associated with decreased risk of CVD (highest vs. lowest quartile HR = 0.62, 95% CI 0.43-0.89; P-trend = 0.008). The association for trunk fat was attenuated yet remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher percent trunk fat combined with lower percent leg fat was associated with particularly high risk of CVD (HR comparing extreme groups = 3.33, 95% CI 1.46-7.62). CONCLUSION: Among postmenopausal women with normal BMI, both elevated trunk fat and reduced leg fat are associated with increased risk of CVD. Published on behalf of the European Society of Cardiology. All rights reserved.
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