Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index

Guo Chong Chen, Rhonda Arthur, Neil M. Iyengar, Victor Kamensky, Xiaonan (Nan) Xue, Sylvia Wassertheil-Smoller, Matthew A. Allison, Aladdin H. Shadyab, Robert A. Wild, Yangbo Sun, Hailey R. Banack, Jin Choul Chai, Jean Wactawski-Wende, Jo Ann E. Manson, Marcia L. Stefanick, Andrew J. Dannenberg, Thomas E. Rohan, Qibin Qi

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)2849-2855
Number of pages7
JournalEuropean heart journal
Volume40
Issue number34
DOIs
StatePublished - Sep 7 2019

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Adipose Tissue
Body Mass Index
Cardiovascular Diseases
Fats
Leg
Confidence Intervals
Waist-Hip Ratio
Photon Absorptiometry
Adiposity
Waist Circumference
Women's Health
Body Composition
Coronary Disease
Life Style
Stroke
Demography

Keywords

  • Body fat
  • Cardiovascular disease
  • Metabolically unhealthy normal weight
  • Normal-weight obesity
  • Postmenopausal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index. / Chen, Guo Chong; Arthur, Rhonda; Iyengar, Neil M.; Kamensky, Victor; Xue, Xiaonan (Nan); Wassertheil-Smoller, Sylvia; Allison, Matthew A.; Shadyab, Aladdin H.; Wild, Robert A.; Sun, Yangbo; Banack, Hailey R.; Chai, Jin Choul; Wactawski-Wende, Jean; Manson, Jo Ann E.; Stefanick, Marcia L.; Dannenberg, Andrew J.; Rohan, Thomas E.; Qi, Qibin.

In: European heart journal, Vol. 40, No. 34, 07.09.2019, p. 2849-2855.

Research output: Contribution to journalArticle

Chen, GC, Arthur, R, Iyengar, NM, Kamensky, V, Xue, XN, Wassertheil-Smoller, S, Allison, MA, Shadyab, AH, Wild, RA, Sun, Y, Banack, HR, Chai, JC, Wactawski-Wende, J, Manson, JAE, Stefanick, ML, Dannenberg, AJ, Rohan, TE & Qi, Q 2019, 'Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index', European heart journal, vol. 40, no. 34, pp. 2849-2855. https://doi.org/10.1093/eurheartj/ehz391
Chen, Guo Chong ; Arthur, Rhonda ; Iyengar, Neil M. ; Kamensky, Victor ; Xue, Xiaonan (Nan) ; Wassertheil-Smoller, Sylvia ; Allison, Matthew A. ; Shadyab, Aladdin H. ; Wild, Robert A. ; Sun, Yangbo ; Banack, Hailey R. ; Chai, Jin Choul ; Wactawski-Wende, Jean ; Manson, Jo Ann E. ; Stefanick, Marcia L. ; Dannenberg, Andrew J. ; Rohan, Thomas E. ; Qi, Qibin. / Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index. In: European heart journal. 2019 ; Vol. 40, No. 34. pp. 2849-2855.
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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.",
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AU - Chen, Guo Chong

AU - Arthur, Rhonda

AU - Iyengar, Neil M.

AU - Kamensky, Victor

AU - Xue, Xiaonan (Nan)

AU - Wassertheil-Smoller, Sylvia

AU - Allison, Matthew A.

AU - Shadyab, Aladdin H.

AU - Wild, Robert A.

AU - Sun, Yangbo

AU - Banack, Hailey R.

AU - Chai, Jin Choul

AU - Wactawski-Wende, Jean

AU - Manson, Jo Ann E.

AU - Stefanick, Marcia L.

AU - Dannenberg, Andrew J.

AU - Rohan, Thomas E.

AU - Qi, Qibin

PY - 2019/9/7

Y1 - 2019/9/7

N2 - 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.

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KW - Metabolically unhealthy normal weight

KW - Normal-weight obesity

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