More visceral fat linked to worse HDL metrics during menopause transition
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Women with more visceral adipose tissue during menopause transition have worse HDL metrics, and insulin resistance is a mediating factor in some of the associations, according to study data.
“Visceral fat accumulation in the abdomen and around the heart is linked to detrimental changes in the composition, size and function of HDL in women close to the menopause transition,” Samar R. El Khoudary, PhD, MPH, FAHA, vice chair for education of epidemiology and associate professor of epidemiology at the University of Pittsburgh School of Public Health, and Alexis Nasr, PhD, a graduate student researcher at the University of Pittsburgh, told Healio. “Part of the link between visceral fat and HDL metrics may be mediated by insulin resistance in such a way that accumulation of visceral fat worsens insulin resistance during midlife, which may, in turn, lead to worsening of these HDL metrics.”
El Khoudary, Nasr and colleagues analyzed data from 299 women who participated in the Study of Women’s Health Across the Nation (SWAN) HDL ancillary study (mean age, 51.1 years; 67% white). Participants with any adipose tissue measure followed by a later measure of HDL metrics were included. Adipose tissue measures in the study included abdominal visceral adipose tissue, epicardial adipose tissue, paracardial adipose tissue and perivascular adipose tissue. Participants were divided into tertiles based on visceral fat volume in each category. HDL metrics included HDL cholesterol efflux capacity, HDL phospholipids, HDL triglycerides, HDL cholesterol, apolipoprotein A-I and HDL particles.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
In multivariable analysis of associations between adipose tissue and HDL metrics, women with higher levels of abdominal visceral adipose tissue had lower levels of HDL phospholipids (P for trend = .02). Women in the higher abdominal (P for trend = .008) and paracardial adipose tissue tertiles (P for trend = .04) had lower levels of HDL cholesterol.
In multivariable analysis of associations between adipose tissue and HDL subclasses and size, women in the higher tertiles for abdominal visceral adipose tissue and paracardial adipose tissue had lower levels of large HDL phospholipids and smaller overall sizes. Those in the highest tertiles of epicardial adipose tissue had higher levels of small HDL phospholipids (P for trend = .02).
For abdominal visceral adipose tissue, insulin resistance mediated 62% of the associations with HDL cholesterol efflux capacity, 50.9% of the associations with HDL cholesterol, 32.1% of the associations with large HDL phospholipids and 34.5% of the associations with HDL size. For paracardial adipose tissue, insulin resistance mediated 51.6% of the associations with HDL cholesterol, 44.9% of the associations with large HDL phospholipids and 37.1% of the associations with HDL size. Insulin resistance also mediated 34.7% of the associations between perivascular adipose tissue and HDL cholesterol efflux capacity.
“We were surprised by the magnitude of insulin resistance as a mediator on the associations between visceral fat accumulation and the HDL metrics,” El Khoudary and Nasr said. “Insulin resistance appeared to mediate almost half of the associations between visceral fat depots accumulation and the detrimental profile of HDL metrics, which raises the hypothesis on whether controlling insulin resistance in midlife women could limit the associations between visceral fat and loss of the anti-atherogenic properties of the HDL.”
El Khoudary and Nasr said more research is needed to evaluate associations in other female populations, the effect interventions and lifestyle factors may have on associations and how new treatments may improve HDL function, composition and subclasses.
For more information:
Samar R. El Khoudary, PhD, MPH, FAHA, can be reached at elkhoudarys@edc.pitt.edu.
Alexis Nasr, PhD, can be reached at ayn3@pitt.edu.
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