• Nicholas J Alvey, Alison Pedley, Klara J Rosenquist, Joseph M Massaro, Christopher J O'Donnell, Udo Hoffmann, and Caroline S Fox.
• Harvard Medical School, Boston, MA (N.J.A.) National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (N.J.A., A.P., K.J.R., C.J.D., C.S.F.).
• J Am Heart Assoc. 2014 Aug 28; 3 (4).

BackgroundEctopic fat density is associated with cardiovascular disease (CVD) risk factors above and beyond fat volume. Volumetric measures of ectopic fat have been associated with CVD risk factors and subclinical atherosclerosis. The aim of this study was to investigate the association between fat density and subclinical atherosclerosis.Methods And ResultsParticipants were drawn from the Multi-Detector Computed Tomography (MDCT) substudy of the Framingham Heart Study (n=3079; mean age, 50.1 years; 49.2% women). Fat density was indirectly estimated by computed tomography attenuation (Hounsfield Units [HU]) on abdominal scan slices. Visceral fat (VAT), subcutaneous fat (SAT), and pericardial fat HU and volumes were quantified using standard protocols; coronary and abdominal aortic calcium (CAC and AAC, respectively) were measured radiographically. Multivariable-adjusted logistic regression models were used to evaluate the association between adipose tissue HU and the presence of CAC and AAC. Overall, 17.1% of the participants had elevated CAC (Agatston score [AS]>100), and 23.3% had elevated AAC (AS>age-/sex-specific cutoffs). Per 5-unit decrement in VAT HU, the odds ratio (OR) for elevated CAC was 0.76 (95% confidence interval [CI], 0.65 to 0.89; P=0.0005), even after adjustment for body mass index or VAT volume. Results were similar for SAT HU. With decreasing VAT HU, we also observed an OR of 0.79 (95% CI, 0.67 to 0.92; P=0.004) for elevated AAC after multivariable adjustment. We found no significant associations between SAT HU and AAC. There was no significant association between pericardial fat HU and either CAC or AAC.ConclusionsLower VAT and SAT HU, indirect estimates of fat quality, are associated with a lower risk of subclinical atherosclerosis.© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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