The association between central fat distribution and recurrent CVD events in men and women with non-fatal MI
Bruce, Susan A.
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Visceral fat has been shown to be an important predictor of metabolic alterations that lead to increased cardiovascular disease (CVD) risk factors, morbidity, and mortality. The association between central fat distribution as measured by sagittal abdominal diameter (SAD) and the risk of recurrent coronary events was assessed among a population-based cohort of incident MI survivors. Participants included 996 men and 356 women (mean age 55 ± 8.71 yrs) discharged alive after incident MI from 12 of 15 hospitals in Erie and Niagara (NY) counties between 1996 and 2004. A recurrent cardiovascular event was any non-fatal or fatal ICD 9-coded diagnosis between 390 and 450 event or a revascularization procedure (CABG, PTCA or stenting). All-cause mortality was considered to be any death that occurred during the study period due to any cause. The mean follow-up time was 4.01 ± 2.6 yrs. Interviews and self-administered follow-up surveys were used to collect pertinent information and a search of the National Death Index Plus database was completed as of 12/31/04. One-hundred ninety-one (191) men and 85 women experienced a recurrent cardiovascular event. Using Cox's Proportional Hazards analyses, the risk of a recurrent CVD event in women increased by 7% for every 1 cm of SAD increase (HR=1.07; 95% CI 1.01-1.14) and, in men, by 3% for every 1 cm of SAD increase (HR= 1.03; 95% CI .99-1.08). In women, SAD was the better predictor of recurrent cardiovascular events when compared with waist circumference (WC) while WC was the better predictor in men. A J-shaped curve was present in both genders when recurrent CVD events and BMI quartiles were examined. It persisted only in men after the first 24 months of study participation and current smokers were eliminated. WC was the better predictor of all-cause mortality for both men and women when compared to SAD and BMI. After adjusting for secondary prevention interventions--statin, aspirin, and beta-blocker use and physical activity --- the risk of recurrent event was observed to decrease by about only 1% for each gender. These results suggest that SAD is positively associated with a recurrence of cardiovascular events after incident MI in both men and women. The absence of decreased risk with secondary prevention interventions suggests that more investigation into the association of central abdominal fat and secondary prevention management is warranted.