What is the clinical evidence from this study?

Study design: Cohort. Population: Obesity (n=972). Intervention: Visceral adipose tissue (VAT) vs. Lower levels of VAT (per 1 SD change). Primary outcome: Composite of first or subsequent CVD event (HR 1.21, 95% CI 1.03 to 1.43).

What question did this study set out to answer?

To evaluate the associations of imaging-derived markers of regional adiposity—including visceral, abdominal subcutaneous, lower body subcutaneous, and liver fat—with incident cardiovascular disease in obese adults.

September 3, 2026Journal of the American College of CardiologyOpen Access

Body Fat Distribution and Incident Cardiovascular Disease in Obese Adults

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Key result

Visceral fat linked to ~21% higher CVD risk in obese adults, contrasting lower-body fat.

HR 1.21
95% CI 1.03 to 1.43
n=972

Why the study?

Significant heterogeneity exists in the cardiometabolic risk associated with excess body fat in obese individuals.

Does body fat distribution (VAT vs LBAT) affect the risk of incident cardiovascular disease in obese adults?

Key Points

To evaluate the associations of imaging-derived markers of regional adiposity—including visceral, abdominal subcutaneous, lower body subcutaneous, and liver fat—with incident cardiovascular disease in obese adults.
Followed 972 obese participants (mean age 44 years, 62% women, 54% African-Americans) from the Dallas Heart Study for a median of 9.1 years.
Quantified visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) via MRI, lower body subcutaneous adipose tissue (LBAT) via DEXA, and liver fat via magnetic resonance spectroscopy.
Assessed incident composite cardiovascular disease (CVD) events using multivariate-adjusted marginal Cox proportional hazards modeling.
Visceral adipose tissue was independently associated with increased CVD risk (HR per 1 SD: 1.21; 95% CI: 1.03 to 1.43), with cumulative incidence rising from 5.3% in quartile 1 to 10.0% in quartile 4.
Lower body subcutaneous adipose tissue was inversely associated with CVD risk (HR per 1 SD: 0.56; 95% CI: 0.44 to 0.72), with cumulative incidence decreasing from 10.0% in quartile 1 to 5.4% in quartile 4.
Body mass index, abdominal subcutaneous adipose tissue, waist circumference, and liver fat were not independently associated with incident cardiovascular disease.

Study Design

Type

Cohort (n=972)

Structured PICO

Does body fat distribution (VAT vs LBAT) affect the risk of incident cardiovascular disease in obese adults?

Population

972 obese adults (mean age 44, 62% women) free of prevalent cardiovascular disease, followed for a median of 9.1 years.

Exposure

Visceral adipose tissue (VAT) and lower body subcutaneous adipose tissue (LBAT) measured by imaging

Comparator

Lower levels of VAT and LBAT

Outcome

Composite of first or subsequent CVD event (cardiovascular death; myocardial infarction, hospitalized unstable angina, or coronary revascularization; ischemic stroke, transient ischemic attack, or cerebrovascular revascularization; peripheral arterial revascularization; hospitalization for heart failure; or hospitalization for atrial fibrillation) at median 9.1 years follow-upcomposite

Main Result

Hazard Ratio: 1.21 (95% CI 1.03–1.43)

Limitations

Larger studies are needed to determine if adipose depot-specific measurement can improve risk assessment or serve as a treatment target

Implication

Advanced imaging of fat distribution reveals that visceral fat increases CVD risk while lower body subcutaneous fat is protective in obese adults.

Abstract

Emerging evidence suggests that significant heterogeneity exists in the cardiometabolic risk associated with excess body fat in obese individuals (1). We investigated the associations of novel imaging markers of adiposity, including visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) by magnetic resonance imaging, lower body subcutaneous adipose tissue (LBAT) by dual-energy x-ray absorptiometry, and liver fat by magnetic resonance spectroscopy, with the risk for cardiovascular disease (CVD) events in a multiethnic cohort of obese adults.

Discussion

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Cite This Study

Neeland et al. (2015) conducted a cohort in Obesity (n=972). Visceral adipose tissue (VAT) vs. Lower levels of VAT (per 1 SD change) was evaluated on Composite of first or subsequent CVD event (HR 1.21, 95% CI 1.03 to 1.43). In obese adults, visceral adipose tissue was associated with an increased risk of cardiovascular disease (HR 1.21 per 1 SD), whereas lower body subcutaneous adipose tissue was associated with a decreased risk.

synapsesocial.com/papers/6a998fd73c1419f58b4789e7 https://doi.org/10.1016/j.jacc.2015.01.061

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Implication

Advanced imaging of fat distribution reveals that visceral fat increases CVD risk while lower body subcutaneous fat is protective in obese adults.

Body Fat Distribution and Incident Cardiovascular Disease in Obese Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Body Fat Distribution and Incident Cardiovascular Disease in Obese Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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