DXA-Measured Visceral Adipose Tissue and Incident Cardiovascular Disease Events in Middle-Aged Adults: Busselton Healthy Ageing Study

BACKGROUND: DXA-measured visceral adipose tissue (VAT) is associated with development of metabolic syndrome in middle-aged adults, but its association with incident cardiovascular disease (CVD) has not been studied. We evaluated the longitudinal association of baseline VAT DXA with incident CVD events within the Busselton Healthy Ageing study.

METHODS: Participants (n = 4866, 54 % female, aged 46-70 years, ∼99 % white) were assessed for VAT DXA and were followed up longitudinally for a median of 7.9 years. Outcome measures were time to incident CVD or coronary heart disease (CHD) events (defined as non-fatal hospitalisations or death). Sex-stratified associations were examined using Cox proportional hazards models adjusting for baseline age, lifestyle factors and prior CVD.

RESULTS: Mean baseline VAT DXA mass was 1678±877 g and 882±600 g in males and females respectively. Incident CVD and CHD events were recorded for 332 (6.8 %) and 245 (5.0 %) study participants. There was a near-linear increase in risk for CVD and CHD events with VAT DXA in both sexes. After covariate adjustment each standard deviation (SD) increment in VAT DXA was associated with a hazard ratio [95 % confidence interval] for incident CVD in males and females of 1.26 [1.11-1.44] and 1.30 [1.10-1.55] respectively, and a hazard ratio for CHD of 1.28 [1.11-1.49] and 1.40 [1.14-1.72] respectively. However, VAT DXA was no longer independently associated with CVD events once adjusted for BMI and waist circumference.

CONCLUSION: VAT DXA has utility for identifying middle-aged adults at greater risk for incident CVD and CHD but further studies are needed to determine if VAT DXA can improve risk discrimination beyond anthropometric measures.