It is well known that obesity is a risk factor for heart disease. Increasingly we are learning that where that fat is stored also has implications for heart disease risk. The most obvious differences in fat storage location can be seen in the fat distributions of men compared to women, or between those who are apple shaped versus pear shaped. In MASALA, fat has been measured from around the heart (pericardial), in the liver (hepatic), in the muscle (intermuscular), in the body cavity (visceral), and under the skin (subcutaneous). The area under the skin is traditionally considered the primary location of fat storage in healthy normal weight individuals. Fat stored in other locations is generally considered to be an indication of obesity or excess fat. We looked at whether fat stored in these different areas had different associations with heart disease risk using the ASCVD risk score.
In MASALA, we found that more fat around the heart and in the body cavity had the strongest associations with heart disease risk, followed by fat in the muscle. The relationships we observed for heart disease risk with fat in the liver and under the skin were different, suggesting that fat stored in these areas may have a different function. These findings support prior research reporting that fat stored in different locations has different properties, functions, and contributions to heart disease risk. More work is needed to understand why fat gets stored in different locations and how we can use this knowledge to reduce heart disease risk.
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