Abstract P363: Ectopic Adiposity is Associated With Abdominal Aorto-Illiac but Not Coronary Artery Calcification Independent of Total Body Adiposity in African Ancestry Men
Authors: Kuipers Allison L , Zmuda Joseph M , Carr J Jeffrey , Terry James G , Nair Sangeeta , Cvejkus Ryan , Bunker Clareann H , Patrick Alan L , Wassel Christina L , Miljkovic Iva 
Published: July 2021

Objective:
While ectopic adiposity is considered a risk factor for many chronic diseases, including cardiovascular disease, the extent to which this association is independent of total adiposity is yet to be established. Vascular calcification, which is associated with greater adiposity, is a subclinical marker of cardiovascular disease that may have varying etiology and clinical implications in different vascular beds. Therefore, our objective was to assess the potential independent associations of total, regional and ectopic adiposity measures with abdominal aorto-iliac calcification (AAC) and coronary artery calcification (CAC).

Methods:
Detailed health history, clinical exam, dual x-ray absorptiometry and computed tomography (CT) scans were obtained in 798 African ancestry men aged ≥40 years (mean(SD): 62.0(8.6)years) recruited without regard to health status from the Tobago Heart Health Study. Vascular calcification was measured by CT in the abdomen (AAC) and chest (CAC). Calcification was scored using the Agatston method and a score ≥10 was considered to be a prevalent calcification. Severity of calcification was modeled using continuous Agatston score in those with any calcification. Multivariable logistic and linear regression models were used to assess the cross-sectional association of adiposity measures with vascular calcification prevalence and severity. All models were adjusted for age, hypertension, diabetes, dyslipidemia, smoking, alcohol intake and sedentary lifestyle. In addition, models of ectopic adiposity (abdominal visceral adipose tissue, liver attenuation and calf skeletal muscle fat) were adjusted for total body fat.

Results:
AAC was present in 63% and CAC was present in 29% of men. After adjustment for traditional cardiovascular risk factors, 1SD greater total, trunk, or abdominal subcutaneous adiposity was associated with 1.3-1.5-fold increased odds of AAC (all p<0.05). After additional adjustment for total body fat, 1SD lower liver attenuation (indicative of greater liver adiposity) or 1SD greater skeletal muscle fat were each associated with a 1.2-1.3-fold increased odds of AAC. In fully adjusted models, only greater BMI or waist circumference was associated with increased odds of CAC (OR 1.2, p<0.05 for both). In fully adjusted linear models of calcification severity, no significant association was observed between any adiposity measure and AAC or CAC.

Conclusions:
Independent of total adiposity, measures of ectopic adiposity were associated with greater AAC, but not CAC, prevalence in African ancestry men. These results highlight potential differences in the adiposity-vascular disease relationship that may vary by ectopic fat depot and vascular bed location. Future vascular disease research should explore potential underlying biologic mechanisms for these findings.