Hypertriglyceridemic Waist: A Simple Marker of High‐Risk Atherosclerosis Features Associated With Excess Visceral Adiposity/Ectopic Fat

LeBlanc, S. J.; François, Clément; Bertrand, Olivier; Bibeau, Karine; Marette, André; Alméras, Natalie; Lemieux, Isabelle; Després, Jean‐Pierre; Larose, Éric

doi:10.1161/jaha.117.008139

Cited by 27 publications

(20 citation statements)

References 63 publications

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“…13 In the CENTRAL-MRI trial, a Mediterranean low carbohydrate dietary pattern was superior to a low fat diet in mobilizing atherogenic and diabetogenic fat depots in liver, pancreas and pericardium; changes in lipid traits related to MetS (triglycerides and triglyceride/high-density lipoprotein cholesterol ratio) correlated with reductions in visceral/hepatic fat, but not with BMI. 14 This supports the notion that visceral, intra-organ and subcutaneous adipose tissue depots have distinct associations with cardiometabolic health, 15,16 and selective mobilization of visceral/ectopic fat is a fundamental mechanism underlying improved metabolic function. Overall, the combination of anthropometric and laboratory markers indicative of visceral adiposity (e.g.…”

Section: Recommendations Regarding Lifestyle Risk Factorssupporting

confidence: 64%

Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors

Lechner

Schacky

McKenzie³

et al. 2019

Eur J Prev Cardiolog

242

156

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Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle–disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.

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Section: Recommendations Regarding Lifestyle Risk Factorssupporting

confidence: 64%

Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors

Lechner

Schacky

McKenzie³

et al. 2019

Eur J Prev Cardiolog

242

156

View full text Add to dashboard Cite

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“…Our ndings are congruent with the cross-sectional studies conducted in a diverse range of other asymptomatic populations including Caucasian men (17), multi-ethnic populations (Aboriginal, Chinese, European, South Asian) (8), Canadian Cree (18), patients with chronic kidney disease (19), patients living with type 2 diabetes (20), and subjects with cardiometabolic risk factors (21) that found a positive correlation between HTGW and subclinical atherosclerosis. In the total area and plaque presence models, presence of elevated WC or elevated TG alone did not correlate with higher total area or higher proportion with plaque presence.…”

Section: Discussionsupporting

confidence: 89%

Association of “Hypertriglyceridemic Waist” with Increased 5-Year Risk of Subclinical Atherosclerosis in a Multi-Ethnic Population: A Prospective Cohort Study

Namdarimoghaddam

Fowokan

Humphries

et al. 2020

Preprint

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Background: Hypertriglyceridemic waist (HTGW), which incorporates measures of waist circumference and levels of triglyceride in blood, could act as an early-stage predictor to identify the individuals at high-risk for subclinical atherosclerosis. Previous studies have explored the cross-sectional association between HTGW and atherosclerosis; however, understanding how this association might change over time is necessary. This study will assess the association between HTGW with five-year subclinical carotid atherosclerosis.Methods: 517 participants of Aboriginal, Chinese, European, and South Asian ethnicities were examined for baseline HTGW and five-year indices of subclinical atherosclerosis (intima media thickness (mm), total area (mm2), and plaque presence). Family history of cardiovascular disease, sociodemographic measures (age, sex, ethnicity, income level, maximum education), and traditional risk factors (systolic blood pressure, smoking status, total cholesterol, high-density lipoprotein cholesterol, body mass index) were incorporated into the models of association. These models used multiple linear regression and logistic regression.Results: Baseline HTGW phenotype is a statistically significant and clinically meaningful predictor of five-year intima media thickness (b = 0.08 [0.04, 0.11], p < 0.001), total area (b = 0.20 [0.07, 0.33], p = 0.002), and plaque presence (OR = 2.17 [1.13, 4.19], p = 0.02) compared to the non-HTGW group independent of sociodemographic factors and family history. However, this association is no longer significant after adjusting for the traditional risk factors of atherosclerosis (p = 0.27, p = 0.45, p = 0.66, respectively). Moreover, change in status of HTGW phenotype does not correlate with change in indices of atherosclerosis over five years.Conclusions: Our results suggest that when the traditional risk factors of atherosclerosis are known, HTGW may not offer additional value as a predictor of subclinical atherosclerosis over five years. Changes in HTGW may not be a reliable progress metric for prevention programs.

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“…8,78 Hypertriglyceridemic waist, a visceral adiposity marker combining elevated waist circumference ( ‡90 cm) and elevated fasting plasma triglycerides ( ‡2 mmol/L), thus has good diagnostic accuracy for the identification of individuals at high risk of ASCVD. 86 Lifestyle link. Adequate intake of EPA+DHA and/or EPA only at doses of >3 and 4 g/day, respectively, is an effective and safe option for lowering triglycerides 87 and hepatic fat content in NAFLD.…”

Section: Hypertriglyceridemic Waistmentioning

confidence: 99%

High-Risk Atherosclerosis and Metabolic Phenotype: The Roles of Ectopic Adiposity, Atherogenic Dyslipidemia, and Inflammation

Lechner

McKenzie²,

Kränkel

et al. 2020

Metabolic Syndrome and Related Disorders

103

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Current algorithms for assessing risk of atherosclerotic cardiovascular disease (ASCVD) and, in particular, the reliance on low-density lipoprotein (LDL) cholesterol in conditions where this measurement is discordant with apoB and LDL-particle concentrations fail to identify a sizeable part of the population at high risk for adverse cardiovascular events. This results in missed opportunities for ASCVD prevention, most notably in those with metabolic syndrome, prediabetes, and diabetes. There is substantial evidence that accumulation of ectopic fat and associated metabolic traits are markers for and pathogenic components of high-risk atherosclerosis. Conceptually, the subset of advanced lesions in high-risk atherosclerosis that triggers vascular complications is closely related to a set of coordinated high-risk traits clustering around a distinct metabolic phenotype. A key feature of this phenotype is accumulation of ectopic fat, which, coupled with age-related muscle loss, creates a milieu conducive for the development of ASCVD: atherogenic dyslipidemia, nonresolving inflammation, endothelial dysfunction, hyperinsulinemia, and impaired fibrinolysis. Sustained vascular inflammation, a hallmark of high-risk atherosclerosis, impairs plaque stabilization in this phenotype. This review describes how metabolic and inflammatory processes that are promoted in large measure by ectopic adiposity, as opposed to subcutaneous adipose tissue, relate to the pathogenesis of high-risk atherosclerosis. Clinical biomarkers indicative of these processes provide incremental information to standard risk factor algorithms and advanced lipid testing identifies atherogenic lipoprotein patterns that are below the discrimination level of standard lipid testing. This has the potential to enable improved identification of high-risk patients who are candidates for therapeutic interventions aimed at prevention of ASCVD.

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Hypertriglyceridemic Waist: A Simple Marker of High‐Risk Atherosclerosis Features Associated With Excess Visceral Adiposity/Ectopic Fat

Cited by 27 publications

References 63 publications

Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors

Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors

Association of “Hypertriglyceridemic Waist” with Increased 5-Year Risk of Subclinical Atherosclerosis in a Multi-Ethnic Population: A Prospective Cohort Study

High-Risk Atherosclerosis and Metabolic Phenotype: The Roles of Ectopic Adiposity, Atherogenic Dyslipidemia, and Inflammation

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