Distinct relationships of compartment-specific fat distribution profiles with cardiovascular ageing and future cardiovascular events
Key result
Higher VAT links to incident CVD, with accelerated heart ageing explaining ~14% of this risk.
- n=34,496
Why the study?
Obesity contributes significantly to CVD, but whether distinct fat depots uniquely influence cardiac ageing and cardiovascular risk beyond anthropometric measures remains unclear.
Do imaging-defined adiposity phenotypes better predict biological heart ageing and incident CVD compared to BMI in individuals without CVD?
Population
34 496 UK Biobank participants without CVD
Comparison
Imaging-defined adiposity phenotypes vs anthropometric measures
Design
Observational cohort study
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Visceral adipose tissue, we all knew, is not good. What was not so clear is that there's a difference between men and women, it seems, in terms of the fat distribution.”
Implication
Imaging phenotypes may refine CVD risk assessment beyond BMI; leaves open whether they improve outcomes or warrant routine use.
Key Points
- To examine associations between MRI-defined adiposity phenotypes, biological heart ageing, and incident cardiovascular disease, and to evaluate whether imaging fat depots add value over standard anthropometric measures.
- Analyzed 34,496 UK Biobank participants (55% female, mean age 63.5 years, median BMI 25.7 kg/m²) without baseline cardiovascular disease who underwent cardiac and abdominal MRI.
- Quantified biological heart age via machine learning from 56 cardiac MRI phenotypes and clustered visceral (VAT), abdominal subcutaneous (ASAT), and pericardial (PAT) adipose tissues using K-means.
- Performed sex-stratified mediation analyses to determine the proportion of incident cardiovascular disease explained by specific fat depots acting through accelerated heart ageing.
- Adiposity clustering identified high- and low-risk fat distribution phenotypes that outperformed conventional BMI categories in association with biological heart age.
- Visceral adipose tissue demonstrated the strongest mediation effect, explaining 14% of its association with incident cardiovascular disease through accelerated heart ageing.
- Pericardial adipose tissue initially showed 10.7% mediation through heart ageing, but this decreased to <1% after adjusting for VAT; associations were consistently more pronounced in males.
Study Design
Type
Cohort (n=34,496)
Structured PICO
Do imaging-defined adiposity phenotypes better predict biological heart ageing and incident CVD compared to BMI in individuals without CVD?
P
Population
34,496 UK Biobank participants without cardiovascular disease (mean age 63.5 years, 55% female) with cardiac and abdominal MRI data.
E
Exposure
Imaging-defined adiposity phenotypes (abdominal visceral adipose tissue [VAT], abdominal subcutaneous adipose tissue [ASAT], and pericardial adipose tissue [PAT] clustered via K-means)
C
Comparator
Anthropometric measures (BMI categories)
O
Outcome
Biological heart ageing (estimated using machine learning from 56 cardiac MRI phenotypes) and incident CVDsurrogate
Visceral adipose tissue is the strongest driver of cardiovascular ageing and incident CVD among fat depots, outperforming BMI and pericardial fat.
Cite This Study
Maldonado-Garcia et al. (2026) conducted a cohort in Without cardiovascular disease (n=34,496). Compartment-specific fat distribution (VAT, ASAT, PAT) vs. Lower-risk adiposity phenotype / BMI categories was evaluated on Biological heart ageing and incident CVD. Visceral adipose tissue (VAT) showed the strongest relationship with incident CVD, explaining 14% of its association with incident CVD through accelerated heart ageing.