Author + information
- Received November 8, 2012
- Revision received May 28, 2013
- Accepted June 18, 2013
- Published online September 3, 2013.
- Kathryn A. Britton, MD, MPH∗,†,
- Joseph M. Massaro, PhD‡,
- Joanne M. Murabito, MD, ScM†,§,
- Bernard E. Kreger, MD†,§,
- Udo Hoffmann, MD, MPH‖ and
- Caroline S. Fox, MD, MPH†,¶,#∗ ()
- ∗Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- †Framingham Heart Study, Framingham, Massachusetts
- ‡Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
- §Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- ‖Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- ¶National Heart, Lung, and Blood Institute and the Center for Population Studies, Framingham, Massachusetts
- #Division of Endocrinology, Metabolism and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Caroline S. Fox, Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, Massachusetts 01702.
Objectives The aim of this study was to determine whether ectopic fat depots are prospectively associated with cardiovascular disease, cancer, and all-cause mortality.
Background The morbidity associated with excess body weight varies among individuals of similar body mass index. Ectopic fat depots may underlie this risk differential. However, prospective studies of directly measured fat are limited.
Methods Participants from the Framingham Heart Study (n = 3,086; 49% women; mean age of 50.2 years) underwent assessment of fat depots (visceral adipose tissue, pericardial adipose tissue, and periaortic adipose tissue) using multidetector computed tomography and were followed up longitudinally for a median of 5.0 years. Cox proportional hazards regression models were used to examine the association of each fat depot (per 1 SD increment) with the risk of incident cardiovascular disease, cancer, and all-cause mortality after adjustment for standard risk factors, including body mass index.
Results Overall, there were 90 cardiovascular events, 141 cancer events, and 71 deaths. After multivariable adjustment, visceral adipose tissue was associated with cardiovascular disease (hazard ratio: 1.44; 95% confidence interval: 1.08 to 1.92; p = 0.01) and cancer (hazard ratio: 1.43; 95% confidence interval: 1.12 to 1.84; p = 0.005). Addition of visceral adipose tissue to a multivariable model that included body mass index modestly improved cardiovascular risk prediction (net reclassification improvement of 16.3%). None of the fat depots were associated with all-cause mortality.
Conclusions Visceral adiposity is associated with incident cardiovascular disease and cancer after adjustment for clinical risk factors and generalized adiposity. These findings support the growing appreciation of a pathogenic role of ectopic fat.
This work was supported by the National Heart, Lung, and Blood Institute’s Framingham Heart Study (contract N01-HC-25195). Dr. Britton was supported by a Research Career Development Award (K12 HL083786) from the National Heart, Lung, and Blood Institute. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
- Received November 8, 2012.
- Revision received May 28, 2013.
- Accepted June 18, 2013.
- American College of Cardiology Foundation