title: The Ratio Between Visceral and Subcutaneous Abdominal Fat Assessed by Computed Tomography Is an Independent Predictor of Mortality and Cardiac Events.
abstract: OBJECTIVE
  Obesity is an important cardiovascular risk factor and the location of fat deposits seems to be an important determinant of its metabolic impact. Visceral adipose tissue (VAT) exerts a harmful effect on metabolic homeostasis, but few longitudinal studies have evaluated the prognostic impact of the ratio of VAT to subcutaneous adipose tissue (SAT). This study aimed to evaluate whether the VAT/SAT ratio was associated with all-cause mortality and cardiac events.
  
  
  METHODS
  Registry-based retrospective cohort study. Eligible patients consisted of those without known heart disease referred to cardiac computed tomography (CT) angiography to evaluate suspected coronary artery disease (CAD). We included all patients with available information on VAT and SAT areas and coronary artery calcium (CAC) score. We assessed the combined endpoint of all-cause mortality, myocardial infarction or revascularization procedure at least 1 month after cardiac CT.
  
  
  RESULTS
  The final population consisted of 713 participants (61% male; mean age, 57.7±10.2 years) followed up for a median of 1.3 years. The combined endpoint occurred in 66 patients; these patients showed a higher VAT/SAT ratio (1.06±0.74 vs 0.80±0.52, P=.0001). The VAT/SAT ratio was an independent predictor of death and cardiac events (HR = 1.43; 95%CI, 1.03-1.99), irrespective of cardiovascular risk factors, CAC, and the presence of CAD.
  
  
  CONCLUSIONS
  The ratio between abdominal VAT/SAT was an independent predictor of death and coronary events, irrespective of cardiovascular risk factors, CAC, and the presence of CAD. This ratio is a CT-derived metric that may help to better identify patients with increased risk of death or cardiac events.
authors.affiliation: Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal. Electronic address: ricardoladeiraslopes@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ladeiras-Lopes
authors.affiliation: Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.affiliation: Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fontes-Carvalho
authors.affiliation: Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.affiliation: Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
authors.affiliation: Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D050507:Subcutaneous Fat, Abdominal / Q000000981:diagnostic imaging*
keywords: Abdominal obesity; Cardiac computed tomography; Cardiovascular disease; Coronariografía por tomografía computarizada; Coronary artery disease; Enfermedad arterial coronaria; Enfermedad cardiovascular; Obesidad abdominal; Tejido adiposo visceral; Visceral adipose tissue