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Associations of visceral adipose tissue and skeletal muscle density with incident stroke, myocardial infarction, and all-cause mortality in community-dwelling 70-year-old individuals: A prospective cohort study
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-9638-7208
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.ORCID iD: 0000-0003-2924-508X
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.ORCID iD: 0000-0001-5050-3720
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sport Sciences, Ui T The Arctic University of Norway, Tromsø, Norway.ORCID iD: 0000-0003-3534-456X
2021 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 10, no 9, article id e020065Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Aging leads to increased visceral adipose tissue (VAT) and reduced skeletal muscle density. To which extent these are associated with the risk of stroke, myocardial infarction (MI), and all-cause mortality in older adults is unknown.

METHODS AND RESULTS: A total of 3294 70-year-old individuals (49.6% women) underwent a health examination in Umeå, Sweden, during 2012 to 2018. VAT and muscle density were measured using dual-energy x-ray absorptiometry and peripheral quantitative computed tomography. Cases of stroke, MI, and all-cause mortality were collected through national registers. Cox regressions were used to calculate hazard ratios (HRs) and 95% CIs per SD greater VAT and per SD lower muscle density. During a mean follow-up of 3.6 years, there were 108 cases of stroke or MI, and 97 deaths. Greater VAT (adjusted HR [aHR], 1.56; 95% CI, 1.09– 2.22), but not lower muscle density (aHR, 1.14; 95% CI, 0.97–1.34), was associated with increased risk of stroke or MI. Neither VAT (aHR, 0.95; 95% CI, 0.65–1.41) nor muscle density (aHR, 1.11; 95% CI, 0.92–1.34) was associated with all-cause mortality. The association of VAT with stroke or MI was only significant in men (aHR, 1.86; 95% CI, 1.19– 2.91) but not women (aHR, 0.60; 95% CI, 0.25–1.42) (Pinteraction =0.038).

CONCLUSIONS: With the limitation of being an observational study, these findings suggest that VAT is an important obesity-related predictor of cardiovascular risk in 70-year-old men, and by implication, that decreasing VAT may potentially reduce their risk of cardiovascular disease.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021. Vol. 10, no 9, article id e020065
Keywords [en]
Body composition, Cardiovascular disease, Ectopic fat, Obesity
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-186217DOI: 10.1161/JAHA.120.020065ISI: 000646630200018PubMedID: 33870709Scopus ID: 2-s2.0-85104300482OAI: oai:DiVA.org:umu-186217DiVA, id: diva2:1580891
Funder
Swedish Research Council, 2016-02589Available from: 2021-07-16 Created: 2021-07-16 Last updated: 2024-07-04Bibliographically approved
In thesis
1. Physical activity, visceral adipose tissue, and cardiovascular disease in older adults: associations and effects
Open this publication in new window or tab >>Physical activity, visceral adipose tissue, and cardiovascular disease in older adults: associations and effects
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Fysisk aktivitet, visceralt fett och kardiovaskulär sjukdom hos äldre personer : samband och effekter
Abstract [en]

BACKGROUND: Cardiovascular disease (CVD) poses a substantial public health burden and is the leading cause of mortality in older adults. With the population aging rapidly, interventions aimed at improving modifiable risk factors for CVD, such as physical inactivity and visceral obesity, could play an important role in reducing its burden, provided they are proven effective.

PURPOSE AND AIMS: The overall purpose of this thesis was to create a deeper understanding of the links between physical activity, visceral adipose tissue (VAT), and CVD in older adults, by studying it from both an observational and an interventional perspective. The specific aims were to investigate the associations of objectively measured physical activity and VAT with the risk of CVD and all-cause mortality, to investigate the effect of structured physical activity (exercise) on VAT, and to review the effects of exercise on CVD and all-cause mortality based on evidence from randomized controlled trials (RCTs).

METHODS: This thesis comprised two prospective cohort studies, one RCT, and one narrative review of evidence from RCTs. The cohort studies included about 3,300 men and women aged 70 years with baseline data on physical activity and VAT mass, as obtained using accelerometry and dual-energy X-ray absorptiometry, respectively. Cases of stroke, myocardial infarction, and all-cause mortality during follow-up were collected from Swedish nationwide registers. The RCT included 77 men and women aged 70 years with visceral obesity who were randomly allocated to either 10 weeks of supervised vigorous-intensity exercise or to no exercise, with VAT mass measured before and after the intervention. In the review, evidence from published RCTs and meta-analyses of RCTs reporting on the effects of exercise on CVD (N=19,162) and all-cause mortality (N=37,443) in general older adults and in individuals with chronic conditions (such as obesity, type 2 diabetes, and preexisting CVD) were reviewed.

MAIN FINDINGS: In the cohort studies, greater amounts of physical activity of any intensity, but especially that of moderate to vigorous intensity, were associated with lower risk of stroke, myocardial infarction, and all-cause mortality. Conversely, greater VAT mass was associated with higher risk of stroke or myocardial infarction. In the RCT, short-term vigorous-intensity exercise seemed to decrease VAT mass slightly, but the effect was not statistically significant. Finally, the review showed that there is currently no convincing evidence from RCTs that exercise effectively reduces the risk of CVD or all-cause mortality, which stands in sharp contrast to the strong associations typically reported in observational studies. The reasons for the conflicting findings are likely complex and multifactorial. In the RCTs, a lack of statistical power could partly explain why no effects have been detected in the general population of older adults, but it is unlikely to explain the null findings in clinical populations, as some of these trials, including meta-analyses of such trials, have been large. Other potential explanations could be a ceiling effect due to the inclusion of participants who were healthier and more physically active than the general population, or that an effect of exercise was masked by the use of effective medications such as antihypertensives and lipid-lowering agents. On the other hand, observational studies have likely overestimated the benefits of physical activity, because these studies are vulnerable to selection bias, reverse causation, and unmeasured confounding, such as from heritable influences.

CONCLUSIONS AND IMPLICATIONS: Despite strong associations, the protective effect of physical activity as a single intervention against CVD and all-cause mortality in older adults is probably not as substantial as is commonly presumed. To uncover the true role of physical activity in preventing CVD, further high-quality trials would be valuable. However, because these trials are very difficult and resource demanding, they should be complemented by innovative observational studies that seek to strengthen causal inference through addressing sources of bias and confounding that are often incompletely accounted for in conventional observational studies. This could include a variety of methodologies, such as utilizing negative control outcomes, instrumental variables, sibling comparisons, and other genetically informed designs. As the aging population continues to grow, it becomes increasingly important to take these scientific steps in order to provide a more definitive answer to the question of the extent to which physical activity alone can reduce the risk of CVD.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2023. p. 117
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2201
Keywords
physical activity, exercise, obesity, stroke, myocardial infarction, death, aging, geriatrics, epidemiology, trial
National Category
Geriatrics Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Research subject
Geriatrics; Epidemiology; Cardiology; Public health; physiotherapy
Identifiers
urn:nbn:se:umu:diva-206734 (URN)978-91-7855-893-3 (ISBN)978-91-7855-894-0 (ISBN)
Public defence
2023-06-02, Aula Biologica, Biologihuset, Linnaeus väg 9, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-05-12 Created: 2023-04-25 Last updated: 2023-04-26Bibliographically approved

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Ballin, MarcelNordström, PeterNiklasson, JohanNordström, Anna

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