Body Fat Distribution, Cardiometabolic Traits, and Risk of Major Lower-Extremity Arterial Disease in Postmenopausal Women

Guo Chong Chen, Rhonda Arthur, Victor Kamensky, Jin Choul Chai, Bing Yu, Aladdin H. Shadyab, Matthew Allison, Yangbo Sun, Nazmus Saquib, Robert A. Wild, Wei Bao, Andrew J. Dannenberg, Thomas E. Rohan, Robert C. Kaplan, Sylvia Wassertheil-Smoller, Qibin Qi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


OBJECTIVE To assess the relationship between body fat distribution and incident lowerextremity arterial disease (LEAD). RESEARCH DESIGN AND METHODS We included 155,925 postmenopausal women with anthropometric measures from the Women’s Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by DXA. Incident cases of symptomatic LEAD were ascertained and adjudicated through medical record review. RESULTS We identified 1,152 incident cases of LEAD during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumferences were positively and inversely associated with risk of LEAD, respectively (both P-trend < 0.0001). In a subset (n 5 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA of insulin resistance (P-trend 5 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend 5 0.0031). In the DXA subset, higher trunk fat (P-trend 5 0.0081) and higher leg fat (P-trend < 0.0001) were associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend 5 0.49), yet the inverse association for leg fat persisted (P-trend 5 0.0082). CONCLUSIONS Among U.S. postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors, especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors.

Original languageEnglish (US)
Pages (from-to)222-231
Number of pages10
JournalDiabetes care
Issue number1
StatePublished - Jan 2022

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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