Key result
Higher upper-body fat was positively associated with incident lower-extremity arterial disease, whereas higher lower-body fat was inversely associated with risk (P-trend < 0.0001).
Why the study?
The relationship between body fat distribution and incident lower-extremity arterial disease (LEAD) was not well established.
Does body fat distribution affect the risk of incident lower-extremity arterial disease in postmenopausal women?
Cohort (n=155,925)
Does body fat distribution affect the risk of incident lower-extremity arterial disease in postmenopausal women?
In postmenopausal women, upper-body fat increases LEAD risk largely through traditional metabolic risk factors, whereas lower-body fat is independently protective against LEAD.
Fat distribution may stratify LEAD risk in postmenopausal women; hypothesis-generating and should not yet change practice.
OBJECTIVE: To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). RESEARCH DESIGN AND METHODS: We included 155,925 postmenopausal women with anthropometric measures from the Women's Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by DXA. Incident cases of symptomatic LEAD were ascertained and adjudicated through medical record review. RESULTS: We identified 1,152 incident cases of LEAD during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumferences were positively and inversely associated with risk of LEAD, respectively (both P-trend < 0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA of insulin resistance (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend < 0.0001) were associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082). CONCLUSIONS: Among U.S. postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors, especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors.
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Chen et al. (2021) conducted a cohort in lower-extremity arterial disease (n=155,925). Body fat distribution was evaluated on incident lower-extremity arterial disease (p=< 0.0001). Higher upper-body fat was positively associated with incident lower-extremity arterial disease, whereas higher lower-body fat was inversely associated with risk (P-trend < 0.0001).
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