Central Obesity and Visceral Adipose Tissue Are Not Associated With Incident Atherosclerotic Cardiovascular Disease Events in Older Men

Abstract

BackgroundVisceral adipose tissue (VAT) and other measures of central obesity predict incident atherosclerotic cardiovascular disease (ASCVD) events in middle‐aged individuals, but these associations are less certain in older individuals age 70 years and older. Our objective was to estimate the associations of VAT and the android–gynoid fat mass ratio, another measure of central obesity, with incident ASCVD events among a large cohort of older men.Methods and ResultsTwo thousand eight hundred ninety‐nine men (mean [SD] age 76.3 [5.5] years) enrolled in the Outcomes of Sleep Disorders in Older Men study had rigorous adjudication of incident ASCVD events (myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke). We used proportional hazards models to estimate the hazard ratios for incident ASCVD per SD increase of VAT or android–gynoid fat mass ratio (measured at baseline with dual‐energy absorptiometry), adjusted for age, race, education, systolic blood pressure, smoking status, oxidized low‐density lipoprotein level, treatment for hypertension, statin use, aspirin use, presence of diabetes mellitus, and study enrollment site. Over a mean (SD) follow‐up period of 7.9 (3.4) years, 424 men (14.6%) had an incident ASCVD event. Neither VAT nor android–gynoid fat mass ratio were associated with incident ASCVD events, either unadjusted or after multivariable‐adjustment (hazard ratios [95% confidence interval ] per SD increase 1.02 [0.92–1.13] and 1.05 [0.95–1.17], respectively).ConclusionsCentral adipose tissue, as measured by VAT or android–gynoid fat mass ratio, was not associated with incident ASCVD events in this study of older men.

Central Obesity in Older Adults: What Should Be the Priority?

“…The ability to comprehensively assess and evaluate central obesity as a predictor of ASCVD outcomes in a large study of older adults is uncommon, and to our knowledge, this is only the second study to do so. Schousboe et al8 found no significant associations between visceral adipose tissue or android‐gynoid fat mass ratio and ASCVD; and this finding persisted in the subset of their cohort who did not have comorbid conditions and the subset who were overweight or normal weight.…”

“…A possible misinterpretation of the findings from the study by Schousboe et al8 is that central adiposity does not confer cardiovascular risk and that peripheral adiposity may even be beneficial. The investigators report a significant inverse association between ASCVD and gynoid fat mass (presumably containing a preponderance of subcutaneous fat).…”

“…In this issue of the Journal of the American Heart Association ( JAHA ), Schousboe et al examine associations of central adiposity and incident ASCVD in the study of MrOS Sleep (Outcomes of Sleep Disorders in Older Men), an ancillary to the study of MrOS (Osteoporotic Fractures in Men) 8. MrOS Sleep is a large, epidemiologic cohort of older white men with comprehensively measured and adjudicated ASCVD outcomes.…”

“…With regard to measurement error, the increasing use of direct measurements of central obesity, as done by Schousboe et al8 with dual‐energy x‐ray absorptiometry for visceral adipose tissue, helps to minimize the concerns that emerge when proxy measures, such as body mass index, are used in obesity research (Figure). A contemporary approach is the concordant measurement and analysis of subcutaneous fat and lean mass, which allows for better understanding of the underlying cause of CVD in older adults.…”

“…No one study can address all methodologic issues, and despite the complexities inherent to this licne of research, the analyses conducted by Schousboe et al8 extend our thinking about this important health issue. Their findings beg the question as to what should be the health priority for adults older than 70 years?…”