Comentario del Autor: Dr. Ricardo Ladeiras-Lopes

Higher visceral to subcutaneous abdominal fat tissue is associated with increased risk of all-cause mortality and major adverse cardiovascular events, even after considering the traditional risk factors and coronary calcium score.

Obesity is a well-known risk factor for cardiovascular disease. Unfortunately, we still haven’t found a perfect strategy to evaluate the risk contribution of obesity to global cardiovascular risk. Several previously published scientific papers have shed some light on the increasingly recognized deleterious impact of ectopic fat deposits and particular fat storage sites with a strong pro-inflammatory activity. In this work we hypothesized the ratio between the visceral compartment of abdominal fat (with increased metabolic and inflammatory activity) and subcutaneous fat (VAT/SAT ratio) might be associated with higher risk of major cardiovascular events (MACEs) and mortality.

From 1,286 patients referred for cardiac CT at the Department of Cardiology of Gaia Hospital Centre we retrospectively identified patients that would be suitable for the longitudinal analysis. Our key finding was the independent association between visceral to subcutaneous abdominal fat ratio and all-cause mortality and major adverse cardiovascular events – a doubling of the VAT/SAT ratio was associated with a 43% higher risk of death or cardiac events.

It was surprising to see that the association between VAT/SAT ratio and all-cause mortality and major adverse cardiovascular events were still significant after adjusting for coronary calcium and presence of coronary artery disease, further emphasizing the promising role of this index to refine cardiovascular risk in the primary prevention setting.

Different pathophysiological mechanisms including inflammation and increased thrombogenicity might account for the observed effect and should be addressed in future research.


  1. Rev Esp Cardiol. - The Ratio Between Visceral and Subcutaneous Abdominal Fat Assessed by Computed Tomography Is an Independent Predictor of Mortality and Cardiac Events.

Comentario del Dr. Ricardo Ladeiras-Lopes

Dr. Ricardo Ladeiras-Lopes

Dr Ricardo Ladeiras-Lopes is a Cardiologist dedicated to Cardiovascular Imaging at Gaia Hospital Centre and a lecturer at the Faculty of Medicine of the University of Porto. He has been involved in basic, translational and clinical research activity since 2006 with a special interest in heart failure, metabolic syndrome, inflammation and thrombosis. He has authored 21 papers published in peer-reviewed journals with more than 310 citations.

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