Visceral-adiposity-and-risk-of-coronary-heart-dise

VisceraladiposityandriskofcoronaryheartdiseaseinrelativelyleanChineseadults☆,☆☆XianglanZhanga,⁎,Xiao-OuShua,HonglanLib,GongYanga,Yong-BingXiangb,QiuyinCaia,Bu-TianJic,Yu-TangGaob,WeiZhengaaDivisionofEpidemiology,DepartmentofMedicine,VanderbiltUniversitySchoolofMedicine,Nashville,TN,USAbDepartmentofEpidemiology,ShanghaiCancerInstitute,Shanghai,ChinacDivisionofCancerEpidemiologyandGenetics,NCI/NIH,Bethesda,MD,USAabstractarticleinfoArticlehistory:Received18July2012Receivedinrevisedform28November2012Accepted18January2013AvailableonlinexxxxKeywords:VisceraladiposityHeartdiseaseChineseBackground:Thehypertriglyceridemicwaistphenotype(definedusingbothelevatedwaistcircumferenceandtriglycerides)andvisceraladiposityindex(VAI,definedusingwaistcircumference,bodymassindex,tri-glycerides,andhigh-densitylipoproteincholesterol)havebeensuggestedtobeinexpensiveyeteffectivemarkersofvisceral(intra-abdominal)obesityandrelateddysmetabolicstate.Thesemarkersmaybepartic-ularlyusefultoAsianpopulationswhogenerallyhavealowbodyweightbutarepronetovisceraladiposity.Methods:WeexaminedassociationsofthehypertriglyceridemicwaistphenotypeandVAIwithriskofcoro-naryheartdisease(CHD)inanestedcase-controlstudyconductedwithintwoprospectivecohortstudiesofChineseadults.Weidentified355incidentcasesofCHDand697controlsmatchedforsex,age,anddateandtimeofbaselinesamplecollection.Anthropometricandlipidmeasurementswereperformedandusedtode-finethehypertriglyceridemicwaistphenotypeandVAIaccordingtopublishedmethods.Conditionallogisticregressionwasusedtoevaluatetheassociations.Results:CaseshadahigherprevalenceofthehypertriglyceridemicwaistphenotypeandhigherVAIscorethancontrolsinbothsexes.AdjustedoddsratiosofCHDassociatedwithhypertriglyceridemicwaistwere5.18(95%CI,2.46–10.9)and4.63(2.03–10.5)forwomenandmen,respectively.AdjustedoddsratiosofCHDcomparingthehighestvs.lowestquartileofVAIwere4.44(95%CI,2.24–8.82)and4.23(1.99–9.00)forwomenandmen,respectively.Conclusion:Ourstudydemonstrates,forthefirsttime,thatthehypertriglyceridemicwaistphenotypeandhighVAIscoreareassociatedwithsubstantiallyelevatedriskofCHDinChinesemenandwomen.©2013ElsevierIrelandLtd.Allrightsreserved.1.IntroductionSubstantialvariationincardiometabolicriskhasbeenobservedamongindividualswithsimilarlevelsofadiposityasmeasuredbybodymassindex(BMI)[1].Someofthisvariationmayoriginatefromdifferencesinthedistributionandfunctionofadiposetissue[2,3].Intra-abdominalorvisceralfataccumulationhasbeensuggestedtobedirectlyinvolvedinthepathogenesisofinsulinresistanceandassociatedmetabolicdiseasesandcardiovasculardisease(CVD)[2–4].Waistcircumference(WC),ameasureofabdominaladiposity,hasbeenindi-catedtobeabetterpredictorofcardiometabolicriskthanBMI,ameasureofgeneraladiposity[5].ElevatedWChasbeenincludedasoneofthekeycriteriatodefinethemetabolicsyndrome[6].Nevertheless,theinabilityofWCtodistinguishbetweensubcutaneousandvisceraladiposityandtheincreasingrecognitionofthedifferentialmetaboliccharacteristicsbetweenthesetwofatdepotshavestimulatedinterestinevaluatingad-ditionalmarkersreadilyavailableinclinicalsettingsthatmaybettercap-turevisceralobesityandrelateddysmetabolicstate[2,4,7,8].Twosuchmarkershaveemerged,thehypertriglyceridemicwaistphenotypeandthevisceraladiposityindex(VAI)[7,8].Thesemarkersusecombinationsofanthropometricandlipidparametersandhavebeensuggestedtobeinexpensiveyeteffectiveindicatorsofadiposetissuedysfunctionandcardiometabolicrisk[7–9].SomeAsianpopulationsincludingChineseareknowntobepronetovisceralfataccumulationandinsulinresistancedespitehavinggenerallylowBMI[10,11];markersofvisceralobesitymaythusbeparticularlyusefultoAsians.Weevaluated,forthefirsttime,wheth-erthehypertriglyceridemicwaistphenotypeandVAIareassociatedInternationalJournalofCardiologyxxx(2013)xxx–xxx☆Theauthorstakeresponsibilityforallaspectsofthereliabilityandfreedomfrombiasofthedatapresentedandtheirdiscussedinterpretation.☆☆Sourcesofsupport:ThisworkwassupportedbyresearchgrantsR01HL079123,R37CA070867,andR01CA082729fromtheUSNationalInstitutesofHealth.Thecon-tentissolelytheresponsibilityoftheauthorsanddoesnotnecessarilyrepresenttheofficialviewsoftheNationalInstitutesofHealth.⁎Correspondingauthorat:VanderbiltEpidemiologyCenter,VanderbiltUniversityMedicalCenter,2525WestEndAvenue,Suite600,IMPH,Nashville,TN37203-1738,USA.Tel.:[phone];fax:[phone].E-mailaddress:[e-mail](X.Zhang).IJCA-15914;NoofPages50167-5273/$–seefrontmatter©2013ElsevierIrelandLtd.Allrightsreserved.::ZhangX,etal,VisceraladiposityandriskofcoronaryheartdiseaseinrelativelyleanChineseadults,IntJCardiol(2013),(CHD)inChinesemenandwomen.2.Methods2.1.StudypopulationWeconductedanestedcase-controlstudywithintheShanghaiWomen'sHealthStudy(SWHS)andtheShanghaiMen'sHealthStudy(SMHS),twoprospective,population-basedcoho