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Periaortic fat linked with PAD, low ankle-brachial index

Fox CS. Circ Cardiovasc Imaging. 2010;3:515-519.

Issue: November 2010

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Researchers have demonstrated an association between periaortic fat and both peripheral arterial disease and low ankle-brachial index in more than 1,000 members from a community-based population.

“Central obesity is associated with PAD, suggesting that ectopic fat depots may be associated with localized diseases of the aorta and lower-extremity arteries,” the researchers wrote. “We hypothesized that persons with greater amounts of periaortic fat are more likely to have clinical PAD and a low ankle-brachial index (ABI).”

This hypothesis culminated in an analysis of 1,205 individuals (53.7% women; mean age, 65.9 ± 8.9 years) from the Framingham Heart Study Offspring cohort. Researchers measured periaortic fat surrounding the thoracic aorta using a volumetric quantitative approach and also quantified visceral abdominal fat. They defined clinical PAD as a history of intermittent claudication and dichotomized ABI as low (≤0.9) or lower-extremity revascularization vs. normal (>0.9 to <1.4).

Study results indicated that the OR for the combined endpoint per one standard deviation increase in periaortic fat was 1.52 (P=.004), which was heightened with additional adjustment for BMI (OR=1.69; P=.002) or visceral abdominal fat (OR=1.67; P=.009); however, no association was observed for visceral abdominal fat (P=.16). No association was also reported per standard deviation increase in BMI or waist circumference after accounting for visceral abdominal fat (BMI, P=.35; waist circumference, P=.49).

Study limitations included the strictly white study population, which limited generalizability to other races, and the use of thoracic periaortic fat as a proxy measure of perivascular fat through the entire arterial tree due to the researchers’ inability to quantify perifemoral artery fat.

“We demonstrated that periaortic fat is associated with low ABI and intermittent claudication. We did not observe a similar association with BMI, waist circumference or visceral abdominal fat,” the researchers concluded. “Our findings suggest a potential role for periaortic fat in the pathogenesis of PAD.”

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