Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium: Results from The ELSA-Brasil
Introduction
Obesity is a global epidemic of our time with increased mortality and morbidity [1]. Despite its tight connection with other cardiovascular risk factors and metabolic syndrome, it is now clear that different patterns of fat distribution confer heterogeneous additional cardiovascular risk beyond body-mass index (BMI) itself [2], [3], [4], [5]. Body fat distribution is a matter of interest for more than 50 years now [6], [7], yet only recently the study of specific fat depots effects on cardiovascular risk has gained attention [8], [9], [10], [11]. Neck circumference can be described as a marker of upper body subcutaneous fat deposit, which has been independently associated with several cardiometabolic risk factors such as total cholesterol [9], [10], HDL-cholesterol [9], [10], LDL-cholesterol [8], [10], triglycerides [8], [10], [11], systolic and diastolic blood pressure levels [8], [9], [10] and fasting glucose [8], [10]. These associations were reported in observational studies of diverse populations as significant even after multivariate adjustment including BMI and waist circumference. Changes in neck circumference were also correlated with changes in cardiovascular risk profile [12]. Some studies have also associated neck circumference with measures of metabolic syndrome and insulin resistance, as well [4], [8], [13].
Common carotid intima-media thickness (cc-IMT) is a noninvasive measure that has been used as a surrogate outcome for atherosclerotic disease [14] in population-based [15]and clinical studies [16]. More recently, it has been proposed as a potential predictor of individual cardiovascular risk in clinical practice [17]. As another noninvasive measure of subclinical atherosclerosis, coronary artery calcification (CAC) have also been used for risk prediction of cardiovascular events. The presence and extent of CAC is a well-known predictor of future risk for cardiovascular disease (CVD) and also for all-cause mortality in individuals with no previous history of CVD [18], [19].
The association between neck circumference and both these measurements of subclinical atherosclerosis has been studied in the Framingham Heart Study offspring, where the neck circumference was correlated to internal carotid intima-media thickness (IMT), a marker of subclinical atherosclerosis. In multivariable models, a 1−SD increase in neck circumference was associated with a 0.071 mm increase in internal carotid IMT and with a 0.025 mm increase in common carotid IMT. Both associations remained significant after multivariable adjustment including BMI [20]. Pokharel et al., evaluated cross-sectionally the relationship between neck circumference and subclinical atherosclerosis measured by CAC and carotid plaques in a middle-aged population of retired national football league players. Although they found a high prevalence of CAC and carotid plaques, they did not find any association of these subclinical atherosclerosis indexes with neck circumference [21].
The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is an ongoing prospective cohort study of civil servants with relatively high prevalence of overweight and obesity. Thus, we decided to investigate neck circumference as a potential marker of subclinical atherosclerosis indexes through its association with both cc-IMT and CAC in the ELSA-Brasil São Paulo site.
Section snippets
Methods
ELSA-Brasil is a multicenter prospective cohort, which enrolled 15,105 civil servants aged 35–74 years (54% women) from 6 Brazilian cities (Belo Horizonte, Porto Alegre, Rio de Janeiro, Salvador, São Paulo and Vitória [22], [23], [24]). The study aims to investigate factors associated with the development and progression of CVD, diabetes, and other chronic conditions. Baseline assessment consisted of an evaluation lasting approximately 7 h, which included in-person interviews conducted by
Results
Of the 4152 participants from ELSA-Brasil in Sao Paulo, 2266 were women (50.6 ± 8.4 yrs), and 1886 were men (50.7 ± 9.0 yrs). Main characteristics of our study population are shown in Table 1. Participants included in our study were mostly White, overweight, sedentary and never smokers. Mean neck circumference was 33.6 ± 2.4 cm and 38.8 ± 2.7 cm for women and men, respectively.
Table 2 shows crude and adjusted odds ratio (OR) of 1−SD neck circumference with subclinical atherosclerosis in
Discussion
Neck circumference was significantly associated with cc-IMT for both sexes in this subpopulation from ELSA-Brasil, but not with CAC. Compared to previous reports of Brazilian data, average NC was exactly the same as observed in a previous study for men; but for women, ELSA-Brasil values were lower (33.6 cm in ELSA-Brasil vs. 35.9 cm in previous data) [27]. Our results for cc-IMT were similar to previous data from the Framingham Heart Study. They found a significant association between neck
Funding
The ELSA-Brasil baseline study was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology and CNPq – National Research Council (grants # 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ).
Conflict of interest
The authors declare no conflict of interest.
No part of this manuscript is under consideration for publication elsewhere.
Acknowledgments
The authors would also like to acknowledge the participation of the 15,105 individuals recruited for this study, without whom this study, and those based on the ELSA-Brasil cohort, would not have been possible.
References (43)
- et al.
Increases in central fat mass and decreases in peripheral fat mass are associated with accelerated arterial stiffening in healthy adults: the Amsterdam Growth and Health Longitudinal Study
Am J Clin Nutr
(2011) The degree of masculine differentiation of obesities a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease
Am J Clin Nutr
(1956)- et al.
Neck and waist circumference biomarkers of cardiovascular risk in a cohort of predominantly African-American college students: a preliminary study
J Acad Nutr Diet
(2014) - et al.
Association of coronary artery calcium and coronary heart disease events in young and elderly participants in the multi-ethnic study of atherosclerosis: a secondary analysis of a prospective, population-based cohort Mayo Clinic Proceedings
(2014) - et al.
The relationship between carotid intima-media thickness and carotid plaque in the Northern Manhattan Study
Atherosclerosis
(2015) - et al.
Carotid intima-media thickness value distributions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Atherosclerosis
(2014) - et al.
Assessment by cardiovascular magnetic resonance, electron beam computed tomography, and carotid ultrasonography of the distribution of subclinical atherosclerosis across Framingham risk strata
Am J Cardiol
(2007) - et al.
Ectopic fat and cardiometabolic and vascular risk
Int J Cardiol
(2013) - et al.
Increased epicardial, pericardial, and subcutaneous adipose tissue is associated with the presence and severity of coronary artery calcium
Acad Radiol
(2010) - et al.
Epicardial adipose tissue and coronary artery plaque characteristics
Atherosclerosis
(2010)
Extra-media thickness and epicardial fat: comparison of a novel carotid artery ultrasound index and a well-established cardiac magnetic resonance fat quantification method
Nutr Metab Cardiovasc Dis
Atherosclerotic plaque, adventitia, perivascular fat, and carotid imaging
JACC Cardiovasc Imaging
Variability and reproducibility of carotid structural and functional parameters assessed with transcutaneous ultrasound – results from the SAPALDIA cohort study
Atherosclerosis
Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL study
Am Heart J
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation into Cancer and Nutrition in Norfolk cohort: a population-based prospective study
Circulation
Abdominal visceral and subcutaneous adipose tissue compartments association with metabolic risk factors in the Framingham Heart Study
Circulation
Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing Community Diabetes Study 4
Diabetes Care
The relation of body fat distribution, as assessed by six girth measurements, to diabetes mellitus in women
Am J Public Health
Neck circumference as a novel measure of cardiometabolic risk: the Framingham heart study
J Clin Endocrinol Metab
Synergistic effects of neck circumference and metabolic risk factors on insulin resistance: the Cardiometabolic Risk in Chinese (CRC) study
Diabetol Metab Syndr
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