Obesity has reached epidemic levels globally and is a major contributor to developing cardiovascular disease (CVD).1,2 Obesity is typically classified according to body mass index (BMI), however individuals with similar BMI may have different cardiometabolic and CVD risk profiles due to differences in body fat composition with visceral adiposity being especially associated with adverse cardiovascular outcomes.2 Abdominal visceral adipose tissue (VAT) measured using computed tomography (CT) or magnetic resonance imaging (MRI) has been shown to predict incident CVD events in US cohort studies comprising mostly middle-aged adults with mixed ethnicities.3, 4, 5, 6 However, it remains unclear whether the association is sex-dependent or is additive to BMI and/or waist circumference (WC).5,6

Dual-energy x-ray absorptiometry (DXA) is used clinically to measure bone mineral density (BMD), as well as the assessment of whole body and regional soft tissue composition.7 DXA measured VAT (VATDXA) shows strong agreement with CT and MRI measures,8 and provides a low-cost, low-radiation alternative for VAT assessment. Previous studies, including our own with the Busselton Healthy Ageing Study (BHAS) of “baby boomers” (born 1946-1964), have shown that VATDXA is associated with prevalent metabolic syndrome (MetS) and is an independent predictor of incident MetS, with the associations superior to and additive to BMI and waist circumference (WC).9, 10, 11, 12, 13 To our knowledge, the association of VATDXA with incident cardiovascular disease risk has not been studied.

In this longitudinal study of the BHAS cohort, we investigated if VATDXA measured at baseline was associated with incident CVD or coronary heart disease (CHD) events over a median follow-up of 7.9 years, and whether the associations were independent of baseline BMI and waist circumference.