Visceral adipose tissue and incident cardiovascular disease among individuals without diabetes: an analysis of 15 prospective cohorts from 7 countries in Latin America

Background: Visceral adipose tissue (VAT) may causally contribute to cardiovascular disease (CVD); however, evidence in Latin America is limited. Here, we evaluated the association between estimated VAT (eVAT) and incident CVD among individuals without diabetes and estimated its population-attributable fraction (PAF) using data from the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). Methods: We pooled data from 15 prospective cohorts across 7 countries (n = 23,097; 62% women [n = 14,383], median age 51 years). Baseline eVAT (in grams [g]) was estimated using the Metabolic Score for Visceral Fat (METS-VF) index, incorporating age, sex, an insulin resistance index, and waist-to-height ratio. The primary outcome was incident CVD events, including fatal and non-fatal outcomes. Cause-specific Cox proportional hazards models estimated adjusted hazard ratios (aHR). PAF estimates used scenario-based eVAT quartile reductions. Findings: Over a median follow-up of 4 years (113,622 person-years), 436 participants (1.9%) experienced an incident CVD event (174 fatal; 262 non-fatal). Uniformly age- and sex-standardized incidence rates were 3.8 (95% CI: 3.5–4.2) per 1000 person-years. Each 100 g increase in eVAT was associated with a 4% higher CVD hazard (aHR 1.04, 1.03–1.06). Compared with Q1 (<735 g), those in Q3 (1069–1441 g) and Q4 (≥1441 g) had a higher CVD hazard (Q3 aHR: 1.78 [1.28–2.49]; Q4 aHR: 2.03 [1.48–2.79]; p-for-trend <0.001). Associations were stronger for non-fatal events. In PAF estimates, shifting individuals from Q4 to lower quartiles could prevent 8.8% (2.8%–14.7%) of CVD events over 10 years. Interpretation: Higher eVAT was associated with increased CVD risk in Latin America, supporting the view that modest VAT reductions could decrease regional CVD burden. Funding: CC-LAC was funded by the Wellcome Trust.