Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study

Abstract

Background Coronary artery calcium (CAC) improves cardiovascular event prediction. Visceral adipose tissue (VAT) is a cardiometabolic risk factor that may directly or through its related comorbidities determine the obesity-related risk. A clinical VAT estimator could allow an efficient evaluation of obesity-related risk. We aimed to analyze the effect of VAT and its related cardiometabolic risk factors on CAC progression. Methods CAC was quantified at baseline and after 5 years by computed tomography (CT), determining its progression. VAT and pericardial fat were measured by CT and estimated by a clinical surrogate (METS-VF). Considered cardiometabolic risk factors were: peripheral insulin resistance (IR), HOMA-IR, adipose tissue IR (ADIPO-IR), and adiponectin. Factors independently associated to CAC progression were analyzed by adjusted Cox proportional hazard models, including statin use and ASCVD risk score as covariates. We performed interaction and mediation models to propose possible pathways for CAC progression. Results The study included 862 adults (53 ± 9 years, 53% women), incidence CAC progression rate: 30.2 (95% CI 25.3–35.8)/1000 person-years. VAT (HR: 1.004, 95% CI 1.001–1.007, p < 0.01) and METS-VF (HR: 1.001, 95% CI 1.0–1.001, p < 0.05) independently predicted CAC progression. VAT-associated CAC progression risk was evident among low-risk ASCVD subjects, and attenuated among medium–high-risk subjects, suggesting that traditional risk factors overcome adiposity in the latter. VAT mediates 51.8% (95% CI 44.5–58.8%) of the effect attributable to IR together with adipose tissue dysfunction on CAC progression. Conclusions This study supports the hypothesis that VAT is a mediator of the risk conferred by subcutaneous adipose tissue dysfunction. METS-VF is an efficient clinical surrogate that could facilitate the identification of at-risk adiposity subjects in daily clinical practice.

Is Metabolic Score for Visceral Fat (METS-VF) a Better Index Than Other Adiposity Indices for the Prediction of Visceral Adiposity

“…A recent study by Antonio-Villa et al excluded patients with diabetes, similar to our study, and found that METS-VF strongly correlated with VFA (r=0.75) and effectively identified subjects with increased VFA (AUC 0.84), consistent with our findings. 31 These results suggest that the higher AUC values found compared to the Indian study may be attributed to differences in patient selection, and that METS-VF may be more suitable for identifying individuals at high cardiometabolic risk before the onset of metabolic complications. Notably, the group in which the METS-VF was developed excluded individuals with cardiovascular disease, those taking oral antidiabetic drugs other than metformin, and those with diabetic complications.…”

Predicted visceral adiposity index in relation to risk of coronary heart disease and all-cause mortality: insights from NHANES

“…Visceral adipose tissue (VAT) served as a reliable marker for obesity in patients. Previous investigations consistently demonstrated elevated VAT in individuals with CHD ( 9 ). These studies typically employed computed tomography (CT) or magnetic resonance imaging (MRI) techniques to assess VAT levels.…”

Association between metabolic score of visceral fat and carotid atherosclerosis in Chinese health screening population: a cross-sectional study

“…Although various alternative indices for VAT based on simple anthropometric measurements, such as BMI, WHtR, WC, and waist-to-hip ratio, have been developed, these indices only provide a rough estimate of VAT content from the perspective of body fat distribution and do not adequately reflect the impact of VAT on metabolism [ 33 ]. METS-VF is a clinical estimator of VAT and is more accurate than other traditional visceral fat indices in estimating VAT [ 8 , 9 ]. Peng Yu et al showed that METS-VF was associated with a risk of chronic kidney disease (OR: 2.102, 95% CI: 1.653–2.674, P < 0.001) [ 12 ].…”

“…Moreover, this innovative index has been corroborated through validation with magnetic resonance imaging (MRI) and bioelectrical impedance analysis [ 8 ]. Neftali et al, reported that METS-VF identifies individuals with high VAT (VAT > 127 cm 2 for women, > 152.7 cm 2 for men), with an optimal area under the curve (AUC) (0.84, 95% CI: 0.81–0.87, P < 0.001) [ 9 ].…”