{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:01:54Z","timestamp":1793829714353,"version":"4.6.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>While obesity is a well-established risk factor for cardiovascular disease, the relationship between visceral obesity, as assessed by imaging modalities of visceral adipose tissue (VAT), and the risk of atherosclerotic cardiovascular disease (ASCVD) has been insufficiently explored in large-scale studies, particularly across different body mass index (BMI) categories. We aimed at investigating the association between VAT and aortic distensibility as well as risk of ASCVD and comparing the magnitude of VAT-aortic distensibility and VAT-ASCVD association across BMI groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Leveraging data from the UK Biobank, we examined the association between body weight-normalized VAT (VAT-index, VATi), assessed via abdominal MRI (VATi-MRI) or dual-energy X-ray absorptiometry (DXA; VATi-DXA), and aortic distensibility (a direct local measure of aortic stiffness) as well as the risk of ASCVD over a median follow-up period of 4.7 years. The abdominal MRI sub-cohort of the UK Biobank included 36 829 individuals, among whom 28 888 individuals were additionally evaluated using DXA. VATi was associated with a decrease in ascending aortic distensibility [VATi-MRI adjusted beta = \u22120.05 (95% CI: \u22120.07 to \u22120.04, P &amp;lt; 0.001)]; [VATi-DXA adjusted beta = \u22120.04 (95% CI: \u22120.06 to \u22120.03, P &amp;lt; 0.001)] and increased risk of ASCVD [VATi-MRI: HR 1.16 (95% CI: 1.09\u20131.23, P &amp;lt; 0.001)]; [VATi-DXA: 1.21 (95% CI: 1.13\u20131.3), P &amp;lt; 0.001], adjusted for age, sex, socioeconomic status, lifestyle factors, and cardiometabolic comorbidities. Across BMI categories, these associations were more pronounced in non-obese individuals. The cumulative incidence of ASCVD was higher in individuals with high VATi compared with those with low VATi, consistently observed across BMI categories. With a total of 1461 ASCVD events, incidence rates were higher in individuals with high VATi-MRI (VATi-DXA) compared with low VATi across all BMI categories: 5.3% (5.5%) vs. 2.2% (2.2%) in the normal BMI group, 5.5% (5.7%) vs. 2.5% (2.4%) in the overweight group, and 5.7% (5.9%) vs. 2.1% (2.1%) in the obese group (P log-rank &amp;lt;0.001). Overall, in the multivariable-adjusted Cox proportional hazard model, VATi was associated with increased ASCVD risk, but this association was attenuated when adjusted for the clinical marker of central obesity, the waist-to-hip ratio (WHR). In contrast, the association remained significant in the normal BMI group even after adjusting for WHR [HR for VATi-MRI 1.22 (95% CI: 1.06\u20131.42, P &amp;lt; 0.01); VATi-DXA 1.35 (95% CI: 1.11\u20131.65, P &amp;lt; 0.01)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Visceral obesity, measured by advanced imaging modalities, is linked to greater aortic stiffness and elevated risk of ASCVD, independent of BMI, in individuals without known ASCVD. Notably, these associations were observed mostly in non-obese subjects, with the strongest associations found in the normal BMI group. These findings highlight the additional predictive value of visceral obesity over general measures like BMI or WHR, particularly among non-obese individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf447","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T10:13:00Z","timestamp":1752747180000},"page":"2557-2566","source":"Crossref","is-referenced-by-count":9,"title":["Visceral adipose tissue, aortic distensibility and atherosclerotic cardiovascular risk across body mass index categories"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-5465","authenticated-orcid":false,"given":"Umidakhon","family":"Makhmudova","sequence":"first","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9 , Department of Cardiology, Angiology, and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Klinik\/Centrum, Charit\u00e9platz 1, Berlin 10117 ,","place":["Germany"]},{"name":"Friede Springer\u2014Cardiovascular Prevention Center, Charit\u00e9 Universitaetsmedizin Berlin , Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Wild","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Berlin Institute of Health (BIH), Charite\u2014University Medicine Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Williamson","sequence":"additional","affiliation":[{"name":"Computational Medicine, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , Berlin ,","place":["Germany"]},{"name":"Precision Healthcare University Research Institute (PHURI), Queen Mary University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Steinhagen-Thiessen","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Klinik\/Centrum, Charit\u00e9platz 1, Berlin 10117 ,","place":["Germany"]},{"name":"Friede Springer\u2014Cardiovascular Prevention Center, Charit\u00e9 Universitaetsmedizin Berlin , Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Langenberg","sequence":"additional","affiliation":[{"name":"Computational Medicine, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , Berlin ,","place":["Germany"]},{"name":"Precision Healthcare University Research Institute (PHURI), Queen Mary University of London , London ,","place":["UK"]},{"name":"MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge , Cambridge ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Eils","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Berlin Institute of Health (BIH), Charite\u2014University Medicine Berlin , Berlin ,","place":["Germany"]},{"name":"Health Data Science Unit, Heidelberg University Hospital and BioQuant , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0214-3203","authenticated-orcid":false,"given":"Ulf","family":"Landmesser","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9 , Department of Cardiology, Angiology, and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Klinik\/Centrum, Charit\u00e9platz 1, Berlin 10117 ,","place":["Germany"]},{"name":"Friede Springer\u2014Cardiovascular Prevention Center, Charit\u00e9 Universitaetsmedizin Berlin , Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]},{"name":"Berlin Institute of Health (BIH), Charite\u2014University Medicine Berlin , Berlin ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4275-8066","authenticated-orcid":false,"given":"Anna","family":"Sannino","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9 , Department of Cardiology, Angiology, and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Klinik\/Centrum, Charit\u00e9platz 1, Berlin 10117 ,","place":["Germany"]},{"name":"Friede Springer\u2014Cardiovascular Prevention Center, Charit\u00e9 Universitaetsmedizin Berlin , Hindenburgdamm 30, Berlin 12203 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"2026101219573148200_zwaf447-B1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1093\/eurjpc\/zwae279","article-title":"Obesity and cardiovascular disease: an ESC clinical consensus statement","volume":"32","author":"Koskinas","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"2026101219573148200_zwaf447-B2","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/eurjpc\/zwae025","article-title":"Obesity and cardiovascular health","volume":"31","author":"Welsh","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"2026101219573148200_zwaf447-B3","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","volume":"403","author":"Phelps","year":"2024","journal-title":"The Lancet"},{"key":"2026101219573148200_zwaf447-B4","doi-asserted-by":"crossref","first-page":"e984","DOI":"10.1161\/CIR.0000000000000973","article-title":"Obesity and cardiovascular disease: a scientific statement from the American Heart Association","volume":"143","author":"Powell-Wiley","year":"2021","journal-title":"Circulation"},{"key":"2026101219573148200_zwaf447-B5","first-page":"77","article-title":"Obesity and cardiovascular outcomes: a review","volume":"5","author":"Ghoorah","year":"2016","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026101219573148200_zwaf447-B6","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s12944-018-0856-8","article-title":"Localization of fat depots and cardiovascular risk","volume":"17","author":"Gruzdeva","year":"2018","journal-title":"Lipids Health Dis"},{"key":"2026101219573148200_zwaf447-B7","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/s41467-022-35704-5","article-title":"BMI-adjusted adipose tissue volumes exhibit depot-specific and divergent associations with cardiometabolic diseases","volume":"14","author":"Agrawal","year":"2023","journal-title":"Nat Commun"},{"key":"2026101219573148200_zwaf447-B8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S2213-8587(24)00316-4","article-title":"Definition and diagnostic criteria of clinical obesity","volume":"13","author":"Rubino","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026101219573148200_zwaf447-B9","doi-asserted-by":"crossref","first-page":"827","DOI":"10.7326\/M14-2525","article-title":"Normal-weight central obesity: implications for total and cardiovascular mortality","volume":"163","author":"Sahakyan","year":"2015","journal-title":"Ann Intern Med"},{"key":"2026101219573148200_zwaf447-B10","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.1016\/j.jacc.2014.09.060","article-title":"Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events","volume":"64","author":"Redheuil","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2026101219573148200_zwaf447-B11","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.jacc.2023.01.044","article-title":"The genetic determinants of aortic distention","volume":"81","author":"Pirruccello","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026101219573148200_zwaf447-B12","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1038\/s41366-021-00992-2","article-title":"Central obesity is selectively associated with cerebral gray matter atrophy in 15,634 subjects in the UK biobank","volume":"46","author":"Pflanz","year":"2022","journal-title":"Int J Obes"},{"key":"2026101219573148200_zwaf447-B13","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1038\/s41591-020-1009-y","article-title":"A population-based phenome-wide association study of cardiac and aortic structure and function","volume":"26","author":"Bai","year":"2020","journal-title":"Nat Med"},{"key":"2026101219573148200_zwaf447-B14","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1038\/s41467-025-55879-x","article-title":"Medical history predicts phenome-wide disease onset and enables the rapid response to emerging health threats","volume":"16","author":"Steinfeldt","year":"2025","journal-title":"Nat Commun"},{"key":"2026101219573148200_zwaf447-B15","volume-title":"An R Companion to Applied Regression","author":"Fox","year":"2019","edition":"Third Edition"},{"key":"2026101219573148200_zwaf447-B16","first-page":"546","article-title":"Lateral collinearity and misleading results in variance-based SEM: an illustration and recommendations","volume":"13","author":"Texas A&M International University","year":"2012","journal-title":"J Assoc Inf Syst"},{"key":"2026101219573148200_zwaf447-B17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s12944-025-02550-5","article-title":"Remnant cholesterol in obesity phenotypes: results from NHANES","volume":"24","author":"Yu","year":"2025","journal-title":"Lipids Health Dis"},{"key":"2026101219573148200_zwaf447-B18","doi-asserted-by":"crossref","first-page":"e026361","DOI":"10.1161\/JAHA.122.026361","article-title":"Aortic distensibility measured by automated analysis of magnetic resonance imaging predicts adverse cardiovascular events in UK Biobank","volume":"11","author":"Cecelja","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026101219573148200_zwaf447-B19","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.numecd.2015.01.002","article-title":"Abdominal obesity is associated with arterial stiffness in middle-aged adults","volume":"25","author":"Strasser","year":"2015","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"2026101219573148200_zwaf447-B20","doi-asserted-by":"crossref","first-page":"20536","DOI":"10.1038\/s41598-021-00175-z","article-title":"Association between body fat parameters and arterial stiffness","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"2026101219573148200_zwaf447-B21","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ehjci\/jez279","article-title":"The impact of visceral and general obesity on vascular and left ventricular function and geometry: a cross-sectional magnetic resonance imaging study of the UK Biobank","volume":"21","author":"Van Hout","year":"2020","journal-title":"European Heart Journal\u2014Cardiovascular Imaging"},{"key":"2026101219573148200_zwaf447-B22","doi-asserted-by":"publisher","first-page":"zwaf030","DOI":"10.1093\/eurjpc\/zwaf030","article-title":"Arterial stiffness mediates insulin resistance-related risk of atherosclerotic cardiovascular disease: a real-life, prospective cohort study","author":"Wu","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"2026101219573148200_zwaf447-B23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2023.10.008","article-title":"Increased body weight and central adiposity markers are positively associated with the 20-year incidence of cardiovascular disease: the ATTICA epidemiological study (2002\u20132022)","volume":"121","author":"Georgoulis","year":"2024","journal-title":"Nutrition Research"},{"key":"2026101219573148200_zwaf447-B24","doi-asserted-by":"crossref","first-page":"816144","DOI":"10.3389\/fcvm.2022.816144","article-title":"Association of central obesity with all cause and cause-specific mortality in US adults: a prospective cohort study","volume":"9","author":"Huai","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2026101219573148200_zwaf447-B25","first-page":"e004396","article-title":"Association of central adiposity with adverse cardiac mechanics: findings from the hypertension genetic epidemiology network study","volume":"9","author":"Selvaraj","year":"2016","journal-title":"Circ: Cardiovascular Imaging"},{"key":"2026101219573148200_zwaf447-B26","doi-asserted-by":"crossref","first-page":"e197337","DOI":"10.1001\/jamanetworkopen.2019.7337","article-title":"Association of normal-weight central obesity with all-cause and cause-specific mortality among postmenopausal women","volume":"2","author":"Sun","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026101219573148200_zwaf447-B27","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12933-023-01876-7","article-title":"Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus\u2013a multicenter study in China","volume":"22","author":"Zheng","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"2026101219573148200_zwaf447-B28","doi-asserted-by":"publisher","first-page":"zwaf074","DOI":"10.1093\/eurjpc\/zwaf074","article-title":"Visceral adipose tissue is associated with recurrent cardiovascular events in premature coronary artery disease: sub-analysis of the GEA study cohort","author":"Medina-Urrutia","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"2026101219573148200_zwaf447-B29","doi-asserted-by":"crossref","first-page":"5419","DOI":"10.1210\/jc.2010-1378","article-title":"Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson heart study","volume":"95","author":"Liu","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"2026101219573148200_zwaf447-B30","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1161\/ATVBAHA.111.235846","article-title":"Arteriolar function in visceral adipose tissue is impaired in human obesity","volume":"32","author":"Farb","year":"2012","journal-title":"ATVB"},{"key":"2026101219573148200_zwaf447-B31","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1161\/CIR.0000000000000223","article-title":"Identification of obesity and cardiovascular risk in ethnically and racially diverse populations: a scientific statement from the American Heart Association","volume":"132","author":"Rao","year":"2015","journal-title":"Circulation"},{"key":"2026101219573148200_zwaf447-B32","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.numecd.2020.09.031","article-title":"Increased visceral fat accumulation modifies the effect of insulin resistance on arterial stiffness and hypertension risk","volume":"31","author":"Antonio-Villa","year":"2021","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"2026101219573148200_zwaf447-B33","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12933-023-01807-6","article-title":"Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study","volume":"22","author":"Antonio-Villa","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"2026101219573148200_zwaf447-B34","doi-asserted-by":"crossref","first-page":"920","DOI":"10.2337\/dc09-1825","article-title":"Visceral adiposity Index","volume":"33","author":"Amato","year":"2010","journal-title":"Diabetes Care"},{"key":"2026101219573148200_zwaf447-B35","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1080\/21623945.2021.1893452","article-title":"Dysfunctional adiposity index as a marker of adipose tissue morpho-functional abnormalities and metabolic disorders in apparently healthy subjects","volume":"10","author":"Reyes-Barrera","year":"2021","journal-title":"Adipocyte"},{"key":"2026101219573148200_zwaf447-B36","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1016\/j.clnu.2019.07.012","article-title":"Metabolic score for visceral fat (METS-VF), a novel estimator of intra-abdominal fat content and cardio-metabolic health","volume":"39","author":"Bello-Chavolla","year":"2020","journal-title":"Clinical Nutrition"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwaf447\/63795494\/zwaf447.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/33\/14\/2557\/63795494\/zwaf447.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/33\/14\/2557\/63795494\/zwaf447.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:57:44Z","timestamp":1791849464000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/article\/33\/14\/2557\/8206242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,18]]},"references-count":36,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7,18]]},"published-print":{"date-parts":[[2026,10,13]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwaf447","relation":{},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2025,7,18]]}}}