In this study, Ding et al. performed a sub-analysis in the Multi-Ethnic Study of Atherosclerosis (MESA) in order to investigate the relationship between non-subcutaneous adiposity (e.g., pericardial fat, intra-abdominal [visceral] fat, liver attenuation, and intramuscular fat) and calcified coronary plaque. Computed tomography was used to measure both fat depots and coronary calcium in a sample of 398 participants covering a wide range of ages and adiposity levels. Calcium was present in the coronaries of 219 of the study participants. After adjusting for demographics, lifestyle factors, and height, a 1-SD increment in pericardial fat, intra-abdominal fat, as well as a non-subcutaneous fat index was associated with the presence of coronary calcium (38%, 35%, and 41% increases, respectively, for pericardial fat, intra-abdominal fat, and non-subcutaneous fat index). However, in this model, liver fat, intermuscular fat, and abdominal subcutaneous fat were not associated with the presence of coronary calcium. Moreover, compared to participants with a non-subcutaneous fat index in the bottom quartile, those in the top quartile had a 2.5-fold increase in coronary calcium. Although the authors acknowledged that the study was cross-sectional in design, they suggested that the burden of non-subcutaneous adiposity may be associated with the development of atherosclerosis if prospective studies corroborate their results.
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