Abstract 002: Race and Sex Influence the Associations of Subcutaneous and Visceral Adipose Tissues with Calcified Plaque of the Coronary and Abdominal Aortic Arteries: The Family Heart Study
Authors: Terry J G , Simpson Sean L , Smith Che , Carr J J , Hairston Kristen G , Register Thomas , Ding Jingzhong , North Kari E , Feitosa Mary F , Wojczynski Mary , Borecki Ingrid B 
Published: July 2021

Previous research suggests that visceral adipose tissue (VAT) increases risk for atherosclerosis and specifically arterial calcification, yet the association of subcutaneous adipose tissue (SAT) with calcification is less substantiated. Studies have also noted important race and sex differences in risk of atherosclerosis. In the Family Heart Study, we examined race and sex differences in the pattern of associations of abdominal fat depots with coronary (CAC) and abdominal aorto-iliac (AAC) calcified plaque measured using computed tomography (CT).

Methods-
We used CT to measure abdominal fat volume and arterial calcified plaque in 2,748 participants of European American descent (EA; n=1512 females) and 626 participants of African American descent (AA; n=412 females) in the Family Heart Study. CAC and AAC were defined as present (≥1) or absent (0) based on Agatston scores. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined using logistic regression models adjusted for age, field center, family pedigree, race, and history of coronary heart disease (CHD), diabetes, hypertension, hypercholesterolemia, and smoking.

Results-
The association of SAT and VAT with prevalent CAC and AAC varied with sex and race in multivariable logistic regression models. In males, SAT was strongly associated with both CAC (p=0.001) and AAC (p<0.001) in multivariable models and there was evidence that the associations of SAT with CAC and AAC differed by race (each p
interaction
SAT*race p<0.01). The associations of SAT with CAC and AAC appeared to be stronger in EA males than in AA males. In EA, the OR for CAC for a single SD increase in SAT was 2.17 (95% CI 1.37-3.45) whereas for AA the OR was 1.42 (95% CI 1.17-1.72) per SD increase in SAT. Also, in EA males the OR for AAC per SD increase in SAT was 2.69 (95% CI 1.61-4.50) compared to 1.39 (95% CI 1.11-1.73) in AA males. VAT was significantly associated with prevalent CAC in both EA males (OR=1.96 per SD increase, p=0.02) and AA males (OR=1.26 per SD increase, p=0.02) though there were no significant associations of VAT with AAC among males. In females, both SAT (OR=1.18 per SD increase, p=0.004) and VAT (OR=1.21 per SD increase, p=0.003) were associated with prevalent CAC, but not AAC, in multivariable models and associations did not vary by race.

Conclusions-
Abdominal SAT was associated with both CAC and AAC prevalence in males, and associations appeared to be stronger in EA compared to AA participants. VAT was predictive of CAC in both EA and AA males. In contrast, SAT and VAT were only associated with CAC in females and no differences by race were noted. Our findings suggest that SAT, and by inference obesity, along with VAT may be an important contributors to prevalence of arterial calcification and that race plays a role in associations among males.