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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:331-7 - Vol. 70 Num.05 DOI: 10.1016/j.rec.2016.09.010

The Ratio Between Visceral and Subcutaneous Abdominal Fat Assessed by Computed Tomography Is an Independent Predictor of Mortality and Cardiac Events

Ricardo Ladeiras-Lopes a,b,, Francisco Sampaio a,b, Nuno Bettencourt b, Ricardo Fontes-Carvalho a,b, Nuno Ferreira a,b, Adelino Leite-Moreira b, Vasco Gama a,b

a Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
b Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal

Refers to


Cardiac computed tomography. Visceral adipose tissue. Abdominal obesity. Cardiovascular disease. Coronary artery disease.


Introduction and objectives

Obesity is an important cardiovascular risk factor and the location of fat deposits seems to be an important determinant of its metabolic impact. Visceral adipose tissue (VAT) exerts a harmful effect on metabolic homeostasis, but few longitudinal studies have evaluated the prognostic impact of the ratio of VAT to subcutaneous adipose tissue (SAT). This study aimed to evaluate whether the VAT/SAT ratio was associated with all-cause mortality and cardiac events.


Registry-based retrospective cohort study. Eligible patients consisted of those without known heart disease referred to cardiac computed tomography (CT) angiography to evaluate suspected coronary artery disease (CAD). We included all patients with available information on VAT and SAT areas and coronary artery calcium (CAC) score. We assessed the combined endpoint of all-cause mortality, myocardial infarction or revascularization procedure at least 1 month after cardiac CT.


The final population consisted of 713 participants (61% male; mean age, 57.7 ± 10.2 years) followed up for a median of 1.3 years. The combined endpoint occurred in 66 patients; these patients showed a higher VAT/SAT ratio (1.06 ± 0.74 vs 0.80 ± 0.52, P = .0001). The VAT/SAT ratio was an independent predictor of death and cardiac events (HR = 1.43; 95%CI, 1.03-1.99), irrespective of cardiovascular risk factors, CAC, and the presence of CAD.


The ratio between abdominal VAT/SAT was an independent predictor of death and coronary events, irrespective of cardiovascular risk factors, CAC, and the presence of CAD. This ratio is a CT-derived metric that may help to better identify patients with increased risk of death or cardiac events.


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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved