Visceral adipose tissue and incident cardiovascular disease among individuals without diabetes: an analysis of 15 prospective cohorts from 7 countries in Latin America
Year: 2026
Type: article
Abstract: Background: Visceral adipose tissue (VAT) may causally contribute to cardiovascular disease (CVD); however, evidence in Latin America is limited. Here, we evaluated the association between estimated VAT (eVAT) and incident CVD among individuals without diabetes and estimated its population-attributable fraction (PAF) using data from the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). Methods: We pooled data from 15 prospective cohorts across 7 countries (n = 23,097; 62% women [n = 14,383], median age 51 years). Baseline eVAT (in grams [g]) was estimated using the Metabolic Score for Visceral Fat (METS-VF) index, incorporating age, sex, an insulin resistance index, and waist-to-height ratio. The primary outcome was incident CVD events, including fatal and non-fatal outcomes. Cause-specific Cox proportional hazards models estimated adjusted hazard ratios (aHR). PAF estimates used scenario-based eVAT quartile reductions. Findings: Over a median follow-up of 4 years (113,622 person-years), 436 participants (1.9%) experienced an incident CVD event (174 fatal; 262 non-fatal). Uniformly age- and sex-standardized incidence rates were 3.8 (95% CI: 3.5-4.2) per 1000 person-years. Each 100 g increase in eVAT was associated with a 4% higher CVD hazard (aHR 1.04, 1.03-1.06). Compared with Q1 (<735 g), those in Q3 (1069-1441 g) and Q4 (≥1441 g) had a higher CVD hazard (Q3 aHR: 1.78 [1.28-2.49]; Q4 aHR: 2.03 [1.48-2.79]; p-for-trend <0.001). Associations were stronger for non-fatal events. In PAF estimates, shifting individuals from Q4 to lower quartiles could prevent 8.8% (2.8%-14.7%) of CVD events over 10 years. Interpretation: Higher eVAT was associated with increased CVD risk in Latin America, supporting the view that modest VAT reductions could decrease regional CVD burden. Funding: CC-LAC was funded by the Wellcome Trust.
Authors: Mario Cesar Torres-Chavez, Jesus Ernesto Martinez-Luna, Maria Fernanda Suarez-Velazquez, Carlos Alberto Fermin-Martinez, Rodrigo M. Carrillo-Larco, Dalia Stern, Ian R. Hambleton, Paulo Lotufo, Mariachiara Di Cesare, Anselm Hennis, Catterina Ferreccio, Vilma Irazola, Pablo Perel, Edward W. Gregg, J Jaime Miranda, Majid Ezzati, Goodarz Danaei, Omar Yaxmehen Bello-Chavolla, Neftali Eduardo Antonio-Villa, Adolfo Rubinstein, Aaron Salinas-Rodriguez, Adrian Cortes-Valencia, Alexandre C. Pereira, Alvaro C.C. Maciel, Alvaro Ruiz-Morales, Andrea Huidobro, Andrea R.V.R. Horimoto, Antonio Bernabe-Ortiz, Berenice Rivera-Paredez, Betty S. Manrique-Espinoza, Blanca H. Ceballos, Carla D.O. Bernardo, Carlos A. Aguilar-Salinas, Cassiano R. Rech, Cecilia Baccino, Paula Parnizari, Claudia Bambs, Clicerio Gonzalez-Villalpando, David A. Gonzalez-Chica, Donaji Gomez-Velasco, Elard Koch, Eleonora d'Orsi, Fernando L. Herkenhoff, Fiorella Tartaglione, Flavio D. Fuchs, Gilbert Brenes-Camacho, Gladys E. Maestre, Gloria Beckles, Gonzalo Grazioli, Horacio A. Carbajal, Jackie A. Cooper, Jesus D. Melgarejo, Joao Luiz Bastos, Jorge Salmeron, Jorge Tartaglione, Jose G. Boggia, Jose G. Mill, Juan E. Blumel, Karen G. Peres, Karen Oppermann, Karina M. Paiva, Katia V. Bloch, Lariane M. Ono, Larissa P. Marques, Laura Gutierrez, Leila B. Moreira, Liam Smeeth, Luis J. Mena, Luis Rosero-Bixby, Marco A. Peres, Maria-Elena Gonzalez-Villalpando, Maria Fernanda Lima-Costa, Maria S. Castillo Rascon, Marselle B. Amadio, Martin Lajous, Martin R. Salazar, Miguel Bravo, Nelson A.S. Silva, Nohora I. Rodriguez, Oscar M. Munoz, Paola Casas-Vasquez, Paula Ramirez-Palacios, Pedro J. Ortiz, Poli M. Spritzer, Pollyanna K. Borges, Rafael Velazquez-Cruz, Ramon A. Sanchez, Ramon Alvarez-Vaz, Paula Moliterno, Ricardo O. Guerra, Roberto S. Cunha, Rosalba Rojas-Martinez, Ruy Lopez-Ridaura, Sandra C. Fuchs, Sandra Cortes, Sergio V. Peixoto, Suely G.A. Gimeno, Tania Tello, Thiago L.N. Silva, Veronica Colpani, Walter G. Espeche, William H. Dow
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,930
Funders: Emory University, Harvard T.H. Chan School of Public Health, London School of Hygiene and Tropical Medicine, University of Essex, Wellcome Trust, Imperial College London, Universidade de São Paulo, Universidade Federal do Rio Grande do Norte, Pontificia Universidad Javeriana, Pontificia Universidad Católica de Chile, Agencia Nacional de Investigación y Desarrollo, Pan American Health Organization, Medical Research Council, Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias
Awards: Risk-based Prevention of Heart Disease and Stroke in Latin America and the Caribbean: A Pooled Analysis of Prospective Cohorts and Population-Based Surveys, Risk-based Prevention of Heart Disease and Stroke in Latin America and the Caribbean: A Pooled Analysis of Prospective Cohorts and Population-Based Surveys, G4370016789, CENTER FOR CANCER PREVENTION AND CONTROL (CECAN), G7235645904, CENTRO DE ESTUDIOS AVANZADOS DE ENFERMEDADES CRONICAS (ACCDIS), Worldwide phenotypes and transitions in obesity-related multimorbidity, G99091514
OpenAlex ID: W7204758729