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Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study

Hanley, Carrie, PhD, MPH1; Matthews, Karen, A., PhD1,2; Brooks, Maria, M., PhD1; Janssen, Imke, PhD3; Budoff, Matthew, J., MD4; Sekikawa, Akira, MD, PhD1; Mulukutla, Suresh, MD5; El Khoudary, Samar, R., PhD, MPH, FAHA1

doi: 10.1097/GME.0000000000000945
Original Articles

Objectives: Cardiovascular fat (CF) is associated with greater coronary heart disease (CHD) risk. Postmenopausal women have greater CF volumes than premenopausal women, and the association between specific CF depot volumes and CHD risk is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact CF volumes. Whether racial differences in CF volumes and in their associations with central (visceral fat [VAT]) and general adiposity (body mass index [BMI]) exist in midlife women have not been addressed before.

Methods: In all, 524 participants from the Study of Women's Health Across the Nation (mean age: 50.9 ± 2.9 years; 62% White and 38% Black) who had data on CF volumes (epicardial fat [EAT], paracardial fat [PAT], total heart fat, and aortic perivascular fat), VAT, and BMI were studied.

Results: In models adjusted for age, study site, menopausal status, comorbid conditions, alcohol consumption, and physical activity, Black women had 19.8% less EAT, 24.5% less PAT, 20.4% less total heart fat, and 13.2% less perivascular fat than White women (all P < 0.001). These racial differences remained significant after additional adjustment for BMI or VAT. Race significantly modified associations between adiposity measures and CF volumes. Every 1-SD higher BMI was associated with 66.7% greater PAT volume in White compared with 42.4% greater PAT volume in Black women (P = 0.004), whereas every 1-SD higher VAT was associated with 32.3% greater EAT volume in Black compared with 25.3% greater EAT volume in White women (P = 0.039).

Conclusions: Racial differences were found in CF volumes and in their associations with adiposity measures among midlife women. Future research should determine how race-specific changes in CF volumes impact CHD risk in women.

1University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA

2University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA

3Rush University Medical Center, Department of Preventive Medicine, Pittsburgh, PA

4Los Angeles Biomedical Research Institute, Division of Cardiology, Pittsburgh, PA

5University of Pittsburgh School of Medicine, Department of Medicine, Pittsburgh, PA.

Address correspondence to: Samar R. El Khoudary, PhD, MPH, FAHA, Associate Professor of Epidemiology, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260. E-mail:

Received 17 April, 2017

Revised 2 June, 2017

Accepted 2 June, 2017

Funding/support: This work was supported by the following financial support: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women's Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495).

SWAN Heart was supported by the National Heart, Lung, and Blood Institute (NHLBI) (Grants HL065581, HL065591). The SWAN Cardiovascular Fat Ancillary Study was supported by an award from the American Heart Association (AHA) Great River Affiliation Clinical Research Program: 12CRP11900031.

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.

Financial disclosure/conflicts of interest: Dr Hanley has nothing to disclose; Dr El Khoudary reports grants from AHA, during the conduct of the study; Dr Matthews has nothing to disclose; Dr Brooks reports grants from Gilead Science Inc, outside the submitted work; Dr Janssen reports grants from NIH, during the conduct of the study; Dr Budoff reports grants from NIH, during the conduct of the study; grants from GE, outside the submitted work; Dr Sekikawa has nothing to disclose; Dr Mulukutla has nothing to disclose.

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© 2018 by The North American Menopause Society.