Cardiovascular Fat in Women at Midlife Varies By Race and Body Shape Interview with:

Samar R. El Khoudary, PhD, MPH, BPharm, FAHA Associate Professor, Epidemiology PITT Public Health Epidemiology Data Center University of Pittsburgh Pittsburgh, PA 15260 

Dr. El Khoudary

Samar REl KhoudaryPhDMPH, BPharm, FAHA
Associate Professor, Epidemiology
PITT Public Health
Epidemiology Data Center
University of Pittsburgh
Pittsburgh, PA 15260 What is the background for this study? What are the main findings?

Response: Heart fat is associated with greater coronary heart disease risk. Postmenopausal women have greater heart fat volumes than premenopausal women, and the association between specific heart fat depots and calcification in the coronary arteries is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact heart fat volumes.

We evaluated whether racial differences in heart fat volumes and in their associations with central (abdominal visceral fat) and general adiposity (as measured by body mass index [BMI]) exist in midlife women. Our study included 524 women from the Study of Women’s Health Across the Nation (SWAN) (mean age: 51 years; 62% White and 38% Black) who had data on heart fat volumes, abdominal visceral fat and BMI.

After accounting for the potential health effects of lifestyle and socioeconomic factors we found that midlife Black women had less heart fat volumes than white women and not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart. However, white women with higher BMI had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection. The results echo the findings we have reported previously in midlife men and published at the International Journal of Obesity (2015) 39, 488–494. What should clinicians and patients take away from your report?

Response: A woman’s race and where on her body she packs on pounds at midlife could give valuable clues to her likelihood of having greater volumes of heart fat, a risk factor for coronary heart disease.

As women transition though menopause, they are undergo adverse alterations in body fat composition, lipids, and vascular remodeling that could increase their cardiovascular risk. The midlife stage could be a critical window for optimizing CVD health and initiating early preventions. What recommendations do you have for future research as a result of this study?

Response: The current analysis could not assess changes over time as our study was a cross-sectional investigation. Future studies should assess how changes in central and overall adiposity over time could impact heart fat volumes in different racial/ethnic groups. It would also be interesting to assess whether reducing central fat in black would significantly reduce heart fat and risk of CVD. These studies might help in developing race-specific prevention strategy of cardiovascular disease risk associated with higher heart fat volume. Is there anything else you would like to add?

Response: We’ve now come to very similar conclusions that show excess abdominal fat is worse for both black men and women, and a higher BMI is worse for white men and women when it comes to their odds of having more fat around their hearts. There is something going on here that warrants further investigation to determine why it is happening and what tailored interventions doctors may prescribe to help their patients lower their risk.

Carrie Hanley, Ph.D., M.P.H., of Pitt Public Health, was lead author on this research. Additional authors are Karen A. Matthews, Ph.D., Maria M. Brooks, Ph.D., Akira Sekikawa, M.D., Ph.D., and Suresh Mulukutla, M.D., all of Pitt; Imke Janssen, Ph.D., of Rush University Medical Center; and Matthew J. Budoff, M.D., of the Los Angeles Biomedical Research Institute.

Our study was supported by National Institutes of Health grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, HL065581 and HL065591; and American Heart Association grant 12CRP11900031. Thank you for your contribution to the community.

Citation: Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study.

Hanley, Carrie PhD, MPH; Matthews, Karen A. PhD; Brooks, Maria M. PhD; Janssen, Imke PhD; Budoff, Matthew J. MD; Sekikawa, Akira MD, PhD, PhD; Mulukutla, Suresh MD; El Khoudary, Samar R. PhD, MPH

Menopause:  July 31, 2017
doi: 10.1097/GME.0000000000000945

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 3, 2017 by Marie Benz MD FAAD