title: The association between central fat distribution and recurrent cardiovascular disease events in female survivors of nonfatal myocardial infarction.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The aim of this study was to investigate the association between central fat distribution and the risk of recurrent coronary events among a cohort of female myocardial infarction (MI) survivors.
  
  
  METHODS
  Participants included 356 women (mean ± SD age, 55 ± 8.71 years) discharged alive after an incident MI from hospitals in Erie and Niagara (New York) counties between 1996 and 2004. A recurrent cardiovascular event was any nonfatal or fatal International Classification of Diseases, Ninth Revision-coded diagnosis between 390 and 450. The mean ± SD follow-up time was 4.01 ± 2.6 years. 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.
  
  
  RESULTS
  Eighty-five women experienced a recurrent cardiovascular event. Using Cox proportional hazards analyses, the crude model for body mass index suggested that after incident MI, women had a 39% risk of a recurrent CVD event (hazard ratio [HR], 1.39; confidence interval [CI], 0.76-2.54; P = .293), whereas crude models for waist circumference and sagittal abdominal distention showed the risk to be more than twice as high (HR, 2.12; CI, 1.08-4.16; P = .010; and HR, 2.16; CI, 1.09-4.28; P = .037, respectively). Both measures of central fat distribution appeared to be better predictors of recurrent cardiovascular events when compared with body mass index, whereas sagittal abdominal distention was the better predictor compared with waist circumference, even after multivariate adjustment. After adjusting for secondary prevention interventions-statin, aspirin, β-blocker use, and physical activity-the risk of recurrent event was observed to decrease by about 1%.
  
  
  CONCLUSIONS
  These results suggest that central fat distribution is positively associated with a recurrence of cardiovascular events after incident MI in 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.
authors.affiliation: Susan A. Bruce, PhD, ANP Clinical Associate Professor, School of Nursing, University at Buffalo, New York.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Bruce
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control; D009518:New York / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000453:epidemiology* / Q000517:prevention & control; D012008:Recurrence; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D016387:Women's Health