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

Menopause, epicardial adiposity and preserved ejection fraction heart failure

Postmenopausal women are overrepresented in the preserved ejection heart failure population. Expansion of visceral and epicardial adipose tissue during the menopause transition leads to local and low-grade systemic inflammation that in turn contributes to left ventricular concentric remodeling, diastolic dysfunction and the development and progression of preserved ejection fraction. In contrast to visceral adipose tissue imaging, epicardial adipose tissue can be inexpensively imaged on low radiation coronary calcium score computerized tomography examination. The menopause transition provides a unique time frame to evaluate the contribution of epicardial adipose tissue expansion to the pathogenesis of preserved ejection heart failure.

Relationship Between Perivascular Adipose Tissue and Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis

We conducted a systematic review and meta-analysis aimed at estimating the association between perivascular adipose tissue (PVAT) and some of the cardiovascular risk factors. A systematic search was conducted from January 1980 up to and including 2022 to identify studies that examined the relationship between PVAT and cardiovascular risk factors as obesity and its indices, hypertension, lipids, and glucose intolerance/diabetes. The Medline and Embase databases were searched using the PubMed and Scopus. Data were extracted from 23 studies that fit the criteria. To conduct meta-analysis, we used an approximation of equating the method of correlating assessment because different authors used either Pearson or Spearman correlation. Interrelations of PVAT and body mass index were analyzed in eight studies. Most studies revealed reliable direct correlation; the results of the meta-analysis also showed a significant (P = 0.37, P < 0.01, n = 12,346) correlation. PVAT and waist circumference were analyzed in six studies. Meta-analysis on the selected sample (n = 10,947) showed a significant (r = 0.45, P < 0.01) correlation. Relationship between PVAT and hypertension was revealed in three studies. Direct correlations were found in all studies. Meta-analysis showed the reliability of the correlation dependence (r = 0.21, P < 0.01, n = 3996). PVAT and blood glucose was evaluated in three studies (n = 3689). In each study a reliable (P < 0.05) direct correlation was obtained. Meta-analysis showed a significant correlation of weak strength (r = 0.24, P < 0.01). We demonstrated significant positive correlations of PVAT with the levels of total cholesterol (r = 0.05, P < 0.01), low-density lipoprotein cholesterol (r = 0.13, P < 0.01), and triglycerides (r = 0.29, P < 0.01), and a negative relationship with high-density lipoprotein cholesterol (r = -0.18, P < 0.01) in this meta-analysis. Despite some limitations, the findings of this systematic review and meta-analysis confirmed that PVAT significantly correlates with studied cardiovascular risk factors. Because PVAT presents a great interest in terms of cardiovascular remodeling and cardiovascular disease, its assessment in patients with and without cardiovascular pathology needs further research.

The quantity and quality of cardiovascular fat at mid-life and future cognitive performance among women: The SWAN cardiovascular fat ancillary study

INTRODUCTION

Cardiovascular fat is a novel risk factor that may link to dementia. Fat volume and radiodensity are measurements of fat quantity and quality, respectively. Importantly, high fat radiodensity could indicate healthy or adverse metabolic processes.

METHODS

The associations of cardiovascular fat (including epicardial, paracardial, and thoracic perivascular adipose tissue [PVAT]) quantity and quality assessed at mean age of 51 with subsequent cognitive performance measured repeatedly over 16 years of follow-up were examined using mixed models among 531 women.

RESULTS

Higher thoracic PVAT volume was associated with a higher future episodic memory (β[standard error (SE)] = 0.08 [0.04], P = 0.033), while higher thoracic PVAT radiodensity with lower future episodic (β[SE] = -0.06 [0.03], P = 0.045) and working (β[SE] = -0.24 [0.08], P = 0.003) memories. The latter association is prominent at higher volume of thoracic PVAT.

DISCUSSION

Mid-life thoracic PVAT may have a distinct contribution to future cognition possibly due to its distinct adipose tissue type (brown fat) and anatomical proximity to the brain circulation.

HIGHLIGHTS

Higher mid-life thoracic perivascular adipose tissue (thoracic PVAT) volume is related to a better future episodic memory in women. Higher mid-life thoracic PVAT radiodensity is related to worse future working and episodic memories. Negative association of high thoracic PVAT radiodensity with working memory is prominent at higher thoracic PVAT volume. Mid-life thoracic PVAT is linked to future memory loss, an early sign of Alzheimer's disease. Mid-life women's epicardial and paracardial fat are not related to future cognition.

Correlation between Thyroid Homeostasis and Obesity in Subclinical Hypothyroidism: Community-Based Cross-Sectional Research

OBJECTIVE

It remains unknown whether obesity has an effect on the pituitary-thyroid feedback control axis in subclinical hypothyroidism (SCH). We aimed to investigate the association of thyroid homeostasis with obesity in a SCH population.

METHODS

Our study consisted of a community-based and cross-sectional study from the Epidemiological Survey of Thyroid Diseases in Fujian Province, China. A total of 193 subjects with SCH (90 males and 103 females) without a history of treatment of thyroid disease, such as surgery, radiation, and thyroid hormone or antithyroid medication, were included in the present study. Indices of obesity, including body mass index (BMI), waist circumference (WC), and waist-height ratio (WHtR) were measured.

RESULTS

Our results showed that the secretory capacity of the thyroid gland (SPINA-GT) and Jostel's thyrotropin index (TSHI) were negatively correlated with BMI, WC, and WHtR, whereas the reciprocal of the thyrotroph thyroid hormone resistance index (TTSI-1) was positively correlated with BMI (all p < 0.05). After adjustment for age, sex, smoking, iodine status, and glucolipid metabolism, the associations between TSHI, TTSI (reciprocal transformation), and BMI still persisted (all p < 0.05).

CONCLUSIONS

These results suggest that low levels of thyroid homeostasis indexes may be associated with overall obesity in SCH, rather than central adiposity.

Greater Periaortic Fat Volume at Midlife Is Associated with Slower Gait Speed Later in Life in Women: The SWAN Cardiovascular Fat Ancillary Study

BACKGROUND

Higher perivascular adipose tissue (PVAT) contributes to adverse physiologic alterations in the vascular wall, and thus could potentially limit normal physical function later in life. We hypothesize that higher PVAT volume at midlife is prospectively associated with slower gait speed later in life, independent of overall adiposity and other risk factors.

METHODS

Participants from the Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study were included. PVAT volume around the descending aorta was quantified using existing computed tomography scans at midlife, while gait speed was measured after an average of 10.4 ± 0.7 years.

RESULTS

Two hundred and seventy-six women (aged 51.3 ± 2.8 years at PVAT assessment) were included. Mean gait speed was 0.96 ± 0.21 m/s. Adjusting for study site, race, education level, menopausal status, and length of descending aorta at PVAT assessment, and age, body mass index, difficulty paying for basics, overall health and smoking status at gait speed assessment, a higher midlife PVAT volume was associated with a slower gait speed later in life (p = .03). With further adjustment for presence of any comorbid conditions by the time of gait speed assessment, the association persisted; every 1SD increase in log-PVAT was associated with 3.3% slower gait speed (95% confidence interval: 0.3-6.3%; p = .03).

CONCLUSION

Greater PVAT in midlife women may contribute to poorer physical function in older age supporting a potential role of midlife PVAT in multiple domains of healthy aging. Additional research is needed to fully elucidate the physiologic changes associated with PVAT that may underlie the observed associations.

Ethnic Disparities in Adiposity: Focus on Non-alcoholic Fatty Liver Disease, Visceral, and Generalized Obesity

PURPOSE OF REVIEW

Excessive adiposity has become a public health problem worldwide, contributing to the rise in obesity-related diseases and associated morbidity and mortality. This review details the relative significance of race/ethnicity as it pertains to adiposity and non-alcoholic fatty liver disease (NAFLD).

RECENT FINDINGS

Fat distribution remains a more reliable measure of adiposity than anthropometric measures, with visceral adipose tissue (VAT) associated with increased risk of cardiometabolic disease. While obesity is the most common risk factor for NAFLD, the racial/ethnic prevalence of obesity does not completely parallel NAFLD risk. Combating racial/ethnic disparities in obesity requires understanding differential risk among various groups. Hispanics are disproportionally impacted by NAFLD and have high rates of obesity, VAT, and insulin resistance (IR). This contrasts with Blacks, who have high prevalence of obesity and IR, accompanied by a paradoxically favorable lipid profile and low prevalence of VAT and NAFLD. Many features of adiposity and NAFLD are mediated by genetic and environmental factors, the latter being modifiable and the focus of interventions.

Cognitive flexibility and the health of Black college-attending young adults experiencing interpersonal racial discrimination

This study examined the utility of cognitive flexibility for the health of college-attending Black young adults facing chronic interpersonal racial discrimination in a sample of 218 healthy students attending a predominantly White university in the southeastern United States. Path and simple slope analysis indicated that cognitive flexibility moderated the association between racial discrimination and waist circumference but not depressive symptoms. At high cognitive flexibility, more experiences of discrimination were significantly associated with larger waist circumference. Findings suggest that cognitive flexibility may be detrimental for physical health and not of paramount importance for mental health of college-attending Black young adults.

Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms

The menopause transition (MT) is a critical period of women's lives marked by several physiologic changes and menopause-related symptoms that have implications for health. Risk for cardiovascular disease, the leading cause of death in women, increases after menopause, suggesting a contribution of the MT to its development. This article focuses on the relationship between 2 main features of the MT and women's cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discussed.

Predictive Value of Lipid Accumulation Product, Fatty Liver Index, Visceral Adiposity Index for Metabolic Syndrome According to Menopausal Status

BACKGROUND

The aim of this study is to investigate the value of clinical indicators of metabolic syndrome according to menopausal status in healthy Korean women.

METHODS

The study included 3936 female patients who were managed at Pusan National University Hospital Health Promotion Center from 2008 to 2014. Each patient completed self-report questionnaires and underwent personal interviews with a healthcare provider to assess their past medical history such as any previous disease, medication and/or menstrual histories along with the measurement of her current body size. Lipid accumulation product (LAP), fatty liver index (FLI), visceral adiposity index (VAI), other anthropometric measurements, and laboratory results were evaluated regarding the patient's diagnostic status of metabolic syndrome and menopause.

RESULTS

The prevalence of metabolic syndrome was 11.6% and that of premenopausal and postmenopausal group were 7.0% and 14.6%, respectively. By univariate analysis, the area under the curve of the receiver operating characteristic curve of LAP, VAI, and FLI were 0.93, 0.93, and 0.93, respectively, in premenopausal group, and they were decreased in postmenopausal group, with the value of 0.89, 0.89, and 0.88, respectively.

CONCLUSION

This study showed the predictive values of LAP, VAI, and FLI for metabolic syndrome upon the patient's status of menopause-such markers should be carefully applied in women of menopausal transition.