Visceral Adipose Tissue Measured by DXA, Prevalent Cardiovascular Disease, and Mortality in US Adults: Cross-Sectional and Prospective Analyses from NHANES 2011–2018

Background and aims Visceral adipose tissue (VAT) is a metabolically active fat depot closely linked to cardiometabolic risk. Our aim is to evaluate the association between DXA-measured VAT and both prevalent cardiovascular disease and mortality in younger adults. Methods and results We conducted cross-sectional and prospective analyses using NHANES 2011–2018 data. Adults aged 20–59 with DXA-VAT measurements were included. VAT was analyzed as quartiles and a continuous variable. Prevalent atherosclerotic cardiovascular disease (ASCVD) was assessed cross-sectionally. All-cause and cardiovascular mortality were evaluated prospectively via National Death Index linkage. Survey-weighted logistic regression and Cox proportional hazards models were applied. The final cohort included 11,914 people; 440 (3.7%) had prevalent ASCVD, 213 died from any cause, and 44 from cardiovascular causes. Participants in Q4 had higher odds of ASCVD than Q1 (OR 2.12, 1.32–3.38, p=0.002; p-trend=0.001). Each 1-SD increase in VAT was linked with OR 1.45 (1.26–1.66, p<0.001) for ASCVD, persisting after BMI adjustment (OR 1.40, p=0.001) and further adjustment for mediators (OR 1.24, p=0.040). Over a median follow-up of 5.1 years, VAT per SD was associated with all-cause mortality (HR 1.16; 1.03–1.31; p=0.018), which attenuated after adjustment for BMI. For cardiovascular mortality, Q4 had an HR of 6.28 (1.95–20.2, p=0.002) and VAT per SD, an HR of 1.48 (1.16–1.88, p=0.002). Conclusions In a nationally representative sample of US adults, higher DXA-measured VAT was associated with prevalent ASCVD and cardiovascular mortality, supporting the potential clinical relevance of assessing visceral adiposity for cardiovascular risk stratification.