TABLE 2.

Epidemiological evidence on the association between visceral obesity and incident cardiovascular disease in adults and/or older adults

Author/year	Design population	Outcome	Visceral obesity measurement	Visceral obesity results	Summary
Anthropometric measures—All sample
Chan (2007) 28	Case control study Hong Kong, China Presence of CAD (n = 206) Control group general population (n = 207)	Coronary artery disease	WC ≥ 91.4 cm for men or ≥81.3 cm for women	WC OR = 2.29 (1.29–3.72)	WC Overall—risk
The Emerging Risk Factors Collaboration (2011) 53	Cohort—collaborative analysis of 58 prospective studies 221 934 people in 17 countries 14 297 incident cardiovascular disease outcome	First‐onset cardiovascular disease	WC WHR	After adjustment: WC HR = 1.10 (1.05–1.14) WHR HR = 1.12 (1.08–1.15)	Overall WC—risk WHR—risk
van Wijk (2016) 51	Cohort—European Prospective Investigation of Cancer–Norfolk 7279 participants EPIC‐Norfolk—10‐country collaborative EPIC study	Coronary heart disease	WC ≥ 102 cm in men and ≥89 cm in women	Stratified by C‐reactive protein levels (≥2 mg L−1) WC HR = 1.38 (1.08–1.75)	WC Overall—risk
Feliciano (2017) 22	Cohort—population of Kaiser Permanente Northern California (KPNC) 3109 early‐stage breast cancer (stage I–III) 18 to 80 years without pre‐existing CVD Follow‐up 8.28 years	Cardiovascular disease (CVD) among breast cancer patients	WC—comparing 100 vs. 80 cm	HR: 1.93 (1.31–2.84) WC increased risk of CVD, independent of pre‐existing risk factors.	WC Women—risk
Aune (2016) 56	Systematic review and meta‐analysis of prospective studies 23 prospective studies >15 905 incident cases 647,388 participants	Heart failure	WC—10‐cm increase WHR—0.1‐unit increase	WC RR = 1.29 (CI 1.21–1.37) WHR RR = 1.29 (CI 1.13–1.47)	Overall WC—risk WHR—risk
Anthropometric measures—Sex‐specific and BMI class analyses
Li (2006) 52	Prospective population‐based study, Malmo, Sweden 7 years follow‐up 10 369 men and 16 638 women 45–73 years old	Incidences of first‐cardiac event (CE) and ischemic stroke	WHR Cut‐off points for tertiles of WHR	WHR after adjustments Men Normal weight RR = 1.24 (1.13–1.37) Overweight RR = 1.06 (0.94–1.20) Obesity RR = 1.04 (0.87–1.24) Women Normal weight RR = 1.24 (1.11–1.39) Overweight RR = 1.31 (1.18–1.46) Obesity RR = 1.27 (1.07–1.51)	WHR Men—risk in normal weight Men—NS in overweight Women—risk in normal end overweight
Carlsson (2013) 54	Population‐based study—the Malmö Diet and Cancer study‐cardiovascular cohort 1751 men and 1990 women, aged 60 years without CVD at baseline 11 years of follow‐up	Cardiovascular disease	WC WHR Waist‐hip‐height ratio (WHHR) WC‐to‐height ratio (WCHR) SAD‐to‐height ratio (SADHR) Sagittal abdominal diameter (SAD)	CVD risk factor‐adjusted: Men WC, WHR and WCHR were not associated SAD 1.16 (1.02–1.30 WHHR 1.19 (1.05–1.36) SADHR 1.19 (1.07–1.32) Women Only WHHR 1.20 (1.01–1.43) was associated	Men WC—NS WHR NS WCHR—NS SAD—risk WHHR—risk SADHR—risk Women WC—NS WHR NS WCHR—NS SAD—NS WHHR—risk SADHR—NS
Carlsson (2014) 55	Cohort N 3741 (53% women) 60‐year old without CVD followed for 11‐years	CVD All cases of fatal and nonfatal	WHR WC Sagittal abdominal diameter (SAD) Waist‐hip‐height ratio (WHHR)	Women normal weight (BMI < 25) WHR 1.91 (1.35–2.70) WC 1.81 (1.02–3.20) SAD 1.25 (0.74–2.11) WHHR 1.97 (1.40–2.78) Men normal weight (BMI < 25) WHR, WHHR and WC were not associated SAD only associated CVD HR = 1.19 (1.04–1.35) Adjustments for established risk factors. Women overweight/obese None of the measures were significantly associated. Men overweight/obese All measures were significant predictors WHR 1.24 (1.04–1.47) WC 1.19 (1.00–1.42) SAD 1.21 (1.00–1.46) WHHR 1.23 (1.05–1.44).	Women normal weight WHR—risk WC—risk SAD—risk WHHR—risk Women overweight WHR—NS WC—NS SAD—NS WHHR—NS Men normal weight WHR—NS WC—NS SAD—risk WHHR—NS Men overweight WHR—risk WC—risk SAD—risk WHHR—risk
Body composition variables
Fox (2007) 21	Framingham Heart Study—population‐based 3001 participants free of clinical cardiovascular disease Mean age 50 years	Systolic and diastolic blood pressure (SBP) and (DBP)	Visceral adipose tissue (VAT) Measured by computed tomography	VAT was associated with SBP and DBP (p ≤ 0.0001) in men and women	VAT Overall—risk
Mahabadi (2009) 57	Framingham Heart Study Offspring cohort 1267 participants Mean age 60 years	Prevalence of cardiovascular disease (CVD).	VAT by computed tomography	VAT OR = 1.23 (0.92–1.63) adjustment for traditional risk factor	VAT Overall—NS
Britton (2013) 6	Cohort Framingham Heart Study n = 3086, 49% women, mean age 50.2 years Followed up 5.0 years	Incident cardiovascular disease	VAT by computed tomography	VAT HR 1.44 (1.08–1.92) By sex VAT Women 1.04 (0.65–1.65) Men 1.66 (1.16–2.39)	VAT Overall—risk Women—NS Men—risk
Kouli (2017) 59	Prospective study in Europe—ATTICA study 3,042 adults 10 years follow‐up	Fatal/nonfatal CVD incidence	Visceral adiposity index (VAI)by CT	After adjusting for multiple confounders, VAI OR = 1.05 (1.01–1.10) Men HR = 1.06 (1.00–1.11) Women HR = 1.06 (0.96–1.10)	VAI Overall—risk Women—NS Men—NS
Body composition and anthropometric measures
Nicklas (2004) 60	Health, Ageing and Body Composition Study Follow‐up 4.6 years Men (n = 1,116), women (n = 1,387) Aged 70–79 years	Incident myocardial infarction (MI) Fatal or nonfatal	WC waist‐to‐thigh ratio (WTR) VAT (per 66.23‐cm2 increase) VAT/SAT (per 0.30 increase) VAT/fat mass (per 2.17 increase) Computed tomography	Women WC and WTR were not associated VAT HR = 1.67 (1.28–2.17) VAT/SAT area HR = 1.42 (1.08–1.87) VAT/fat mass HR = 1.67 (1.20–2.31) Men No association were observed WC, WTR, VAT and VAT/SAT	Women WC—NS WTR—NS VAT—risk VAT/SAT—risk VAT/fat mass—risk Men WC—NS WTR—NS VAT—NS VAT/SAT—NS VAT/fat mass—NS
Jasper (2017) 58	‘SMART’ cohort—secondary manifestations of arterial disease Follow‐up 6.8 years, 1767 patients, 18–79 years old	Vascular events Fatal or nonfatal	WC VAT%—visceral fat to total abdominal fat measured by ultrasound	WC Men HR = 1.13 (CI 0.97–1.32) Women HR = 1.00 (CI 0.76–1.32) VAT% HR = 1.15 (0.99–1.34)	WC Men—NS Women—NS VAT—NS