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Age-related differences in abdominal fat distribution in premenopausal and postmenopausal women with cardiovascular disease

van der Leeuw, Joep MD1; Wassink, Annemarie M. J. MD, PhD1; van der Graaf, Yolanda MD, PhD2; Westerveld, Hendrika E. MD, PhD3; Visseren, Frank L. J. MD, PhD1on behalf of the Second Manifestations of ARTerial Disease (SMART) Study Group

doi: 10.1097/gme.0b013e31827212a5
Original Articles

Objective The aim of this study was to determine the effect of sex and the menopausal transition on age-related differences in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) among patients with cardiovascular disease.

Methods A cross-sectional study of 997 women and 3,409 men with cardiovascular disease was performed. VAT and SAT were measured by ultrasonography. Differences in abdominal fat per decade in premenopausal and postmenopausal women were analyzed with linear regression and compared with men younger and older than the mean menopause age of women.

Results VAT increased gradually across advancing age groups. For postmenopausal women, the 10-year differences in VAT were smaller than those for premenopausal women (0.24 cm [β = 0.24; 95% CI, 0.05 to 0.43] vs 0.71 cm [β = 0.71; 95% CI, 0.29 to 1.12]). There were no differences in SAT (β = −0.12; 95% CI, −0.37 to 0.13) in premenopausal women, and SAT decreased across the age groups of postmenopausal women (−0.36 cm per decade [β = −0.36; 95% CI, −0.47 to −0.26]). Postmenopausal women showed 10-year differences in VAT that were larger than those for men 48 years or older (0.24 cm per decade [β = 0.24; 95% CI, 0.05 to 0.43] vs −0.01 cm per decade [β = −0.01; 95% CI, −0.12 to 0.10]). In addition, 10-year differences in SAT were larger in postmenopausal women than in men 48 years or older (−0.36 cm [β = −0.36; 95% CI, −0.47 to −0.26] vs −0.22 cm [β = −0.22; 95% CI, −0.27 to −0.18]).

Conclusions Menopause is not associated with accelerated fat gain in women with cardiovascular disease. Compared with similar-aged men, postmenopausal women show a steeper increase in VAT and a steeper decrease in SAT. These ongoing changes might add to an unfavorable metabolic profile associated with an increased risk of recurrent cardiovascular events.

From the 1Department of Vascular Medicine, 2Julius Center for Health Sciences and Primary Care, and 3Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.

Received May 24, 2012; revised and accepted August 30, 2012.

The members of the SMART Study Group are as follows: A. Algra, MD, PhD; Y. van der Graaf, MD, PhD; D. E. Grobbee, MD, PhD; G. E. H. M. Rutten, MD, PhD, Julius Center for Health Sciences and Primary Care; F.L. J. Visseren, MD, PhD, Department of Internal Medicine; F. L. Moll, MD, PhD, Department of Vascular Surgery; L. J. Kappelle, MD, PhD, Department of Neurology; W. P. T. M. Mali, MD, PhD, Department ofRadiology; P. A. Doevendans, MD, PhD, Department of Cardiology.

Funding/support: The SMART Study was financially supported by a grant from the University Medical Center Utrecht.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Frank L. Visseren, MD, PhD, Department ofVascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands. E-mail:

© 2013 by The North American Menopause Society.