Visceral adipose tissue is associated with recurrent cardiovascular events in premature coronary artery disease: sub-analysis of the GEA study cohort

Aims Visceral adipose tissue (VAT) has been related to coronary artery disease (CAD), but its association with recurrent major adverse cardiovascular events (MACE) in premature CAD (pCAD) has not been fully explored. Thus, we aimed to investigate the impact of VAT on recurrent MACE in patients with pCAD.Methods and results This was a retrospective sub-analysis of 853 patients with pCAD from the GEA cohort study. Visceral adipose tissue was measured by computed tomography at baseline. The primary outcome was the recurrence of MACE over 5 years of follow-up. Likewise, the association of VAT with non-fatal and fatal MACE was analysed as a secondary outcome. Cox regression models were fitted and adjusted by confounders obtained at baseline to estimate adjusted hazard ratios (aHRs). The median age of the patients was 53 years, and 80% were male, with a median follow-up of 4.9 years. Overall, 10% of the patients had recurrent MACE (6.5% non-fatal and 3.6% fatal) with an incidence rate of 18.5 [95% confidence interval (CI): 18.0-19.0] events per 1000 person-years. Visceral adipose tissue was positively associated with MACE. Those in the upper tertile (VAT >= 194 cm(2)) had the highest risk for total (aHR: 2.71; 95% CI: 1.37-5.35; P = 0.004) and non-fatal (aHR: 3.58; 95% CI: 1.49-8.61; P = 0.004) MACE. Fatal MACE was not statistically associated (aHR: 2.13; 95% CI: 0.72-6.35; P = 0.174).Conclusion Among patients with pCAD, VAT increased the risk of recurrent MACE despite adequate pharmacological treatment. These results suggest that VAT could be considered an emergent risk factor and a promising target for residual cardiovascular risk reduction.Lay summary This study explores how visceral adipose tissue (VAT), a type of body fat located around internal organs, elevates the risk of recurrent cardiovascular events in patients with premature coronary artery disease (pCAD), even with optimal medical treatment. Key finding 1: Patients with elevated VAT levels faced a significantly higher risk of recurrent major cardiovascular events. Key finding 2: These results indicate that reducing VAT through lifestyle modifications or targeted interventions could decrease cardiovascular risks in patients with pCAD.Lay summary This study explores how visceral adipose tissue (VAT), a type of body fat located around internal organs, elevates the risk of recurrent cardiovascular events in patients with premature coronary artery disease (pCAD), even with optimal medical treatment. Key finding 1: Patients with elevated VAT levels faced a significantly higher risk of recurrent major cardiovascular events. Key finding 2: These results indicate that reducing VAT through lifestyle modifications or targeted interventions could decrease cardiovascular risks in patients with pCAD.Lay summary This study explores how visceral adipose tissue (VAT), a type of body fat located around internal organs, elevates the risk of recurrent cardiovascular events in patients with premature coronary artery disease (pCAD), even with optimal medical treatment. Key finding 1: Patients with elevated VAT levels faced a significantly higher risk of recurrent major cardiovascular events. Key finding 2: These results indicate that reducing VAT through lifestyle modifications or targeted interventions could decrease cardiovascular risks in patients with pCAD.