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

<b>OBJECTIVE </b> <p>To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). </p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>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 dual energy X-ray absorptiometry (DXA). Incident cases of symptomatic LEAD were ascertained and adjudicated via medical record review.</p> <p><b>RESULTS </b></p> <p>We identified 1152 incident LEAD cases during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumference was positively and inversely associated with risk of LEAD, respectively (both P-trend values <0.0001). In a subset (n = 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-IR (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend <0.0001) was 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 = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082).</p> <p><b>CONCLUSIONS</b></p> <p>Among US 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. </p>