Regional Body Fat and CVD Risk in Postmenopausal Women

Study Questions:

Are regional body fat deposits (trunk or leg fat) associated with altered risk of cardiovascular disease (CVD) among postmenopausal women with normal body mass index (BMI)?


Postmenopausal women with a normal BMI (18.5 to <25 kg/m2) who were participants of the Women’s Health Initiative (WHI) were included in the study. Women with no known CVD at baseline were included. Body composition was determined by dual energy X-ray absorptiometry. Incident CVD events including coronary heart disease and stroke were ascertained through February 2017.


A total of 2,683 women from the WHI were included in the present study. During a median 17.9 years of follow-up, 291 incident CVD cases occurred, including 202 cases of CHD and 105 strokes. After adjustment for demographic, lifestyle, and clinical risk factors, neither whole-body fat mass nor fat percentage was associated with CVD risk. Higher percent trunk fat was associated with increased risk of CVD (highest vs. lowest quartile hazard ratio [HR], 1.91; 95% confidence interval [CI], 1.33–2.74; p-trend < 0.001). In contrast, higher percent leg fat was associated with decreased risk of CVD (highest vs. lowest quartile HR, 0.62; 95% CI, 0.43–0.89; p-trend = 0.008). The association for trunk fat was attenuated yet remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher percent trunk fat combined with lower percent leg fat was associated with particularly high risk of CVD (HR comparing extreme groups, 3.33; 95% CI, 1.46–7.62).


The investigators concluded that among postmenopausal women with normal BMI, both elevated trunk fat and reduced leg fat are associated with increased risk of CVD.


These data add to evidence that fat around the trunk or waist carries an increased risk for CVD events. In contrast, fat in the legs was not associated with an increased risk, and in this study of postmenopausal women, was associated with lower risk. Measuring waist circumference as part of clinical exams could provide important health information for postmenopausal women.

Keywords: Absorptiometry, Photon, Adipose Tissue, Body Composition, Body Mass Index, Cardiovascular Diseases, Coronary Disease, Metabolic Syndrome, Obesity, Postmenopause, Primary Prevention, Risk Factors, Risk Reduction Behavior, Stroke, Vascular Diseases, Waist Circumference, Waist-Hip Ratio, Women

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