Association of obesity and central fat distribution with carotid artery wall thickening in middle-aged women.
OBJECTIVE
The association between obesity and atherosclerotic disease is controversial. In the present analysis, we evaluated whether common carotid intima-media thickness (IMT) and area, 2 markers of preclinical atherosclerosis, were increased in obese subjects.


METHODS
More than 5000 middle-aged women (n=5062; age, 30 to 69 years) living in the area of Naples, Southern Italy, were recruited for a prospective, currently ongoing study on the etiology of cardiovascular disease and cancer in the female population (the Progetto ATENA study). A subsample of 310 participants underwent high-resolution B-mode ultrasound examination, and the IMTs, intima-media areas, and lumen diameters of common carotid arteries were measured with a semiautomated computerized program. Subjects were divided into 3 groups on the basis of the recently published obesity guidelines for body mass index (BMI), a marker of general obesity, and tertiles of waist-to-hip ratio (WHR), a marker of regional obesity.


RESULTS
Women with a BMI >/=30 kg/m(2) showed higher systolic and diastolic blood pressures, triglycerides, and fasting glucose and insulin, as well as lower high-density lipoprotein concentrations, than subjects with lower BMI. A gradual increase in common carotid IMT and intima-media area was observed when lean women (0.94+/-0.01 mm and 19.8+/-0.5 mm(2), respectively) were compared with overweight (0.98+/-0.01 mm and 21.0+/-0.4 mm(2)) and obese (1.02+/-0.02 mm and 22.6+/-0.8 mm(2), P<0.005 for linear trend) individuals. Similarly, women in the highest tertile of WHR (>0.85) had adverse risk factor profiles and thicker carotid intima-media complex than those in the first 2 tertiles (P<0.01 and P<0.05 for IMT and intima-media area, respectively). In multivariate analyses, BMI and WHR were significant predictors of carotid wall thickness, independently of other traditional and nontraditional cardiovascular risk factors (age, blood pressure, lipid abnormalities, fasting insulin).


CONCLUSIONS
The present results indicate a graded and independent association between general and abdominal obesity-reflected by high BMI and WHR-and carotid artery wall thickening in a population of middle-aged women.
De Michele
Mario
M
Departments of Clinical and Experimental Medicine, Federico II, University, Naples, Italy. dspence@robarts.ca
Panico
Salvatore
S
Iannuzzi
Arcangelo
A
Celentano
Egidio
E
Ciardullo
Anna V
AV
Galasso
Rocco
R
Sacchetti
Lucia
L
Zarrilli
Federica
F
Bond
M Gene
MG
Rubba
Paolo
P
D000273:Adipose Tissue / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D001824:Body Constitution; D015992:Body Mass Index; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007558:Italy; D008075:Lipoproteins, HDL / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014654:Vascular Patency
D001786:Blood Glucose; D008076:Cholesterol, HDL; D007328:Insulin; D008075:Lipoproteins, HDL; D014280:Triglycerides