Sex differences in the association of vital exhaustion with regional fat deposition and subclinical cardiovascular disease risk

Objective Vital exhaustion (VE) is more strongly associated with cardiovascular disease (CVD) risk for women than men. This study examined whether sex differences in associations of VE with CVD risk markers are accounted for by unique associations of VE with regional adiposity. Methods The study enrolled 143 persons (18–55 years) without diagnosed conditions. VE was assessed by the Maastricht questionnaire. CVD indices were measured using the euglycemic-hyperinsulinemia clamp, resting blood pressure, and blood draws. Regional adiposity was measured using computed tomography and 2-D echocardiography. This cross-sectional study employed a path analysis approach, including relevant covariates. Results Of the cohort, aged 38.7 ± 8.4 years, 65% were men, and 41% were obese. The final model had excellent fit (χ2(36) = 36.5, p = .45; RMSEA = 0.009, CFI = 0.999). For women, but not men, the model indicated paths from VE to: 1) lower insulin sensitivity (B = −0.10, p = .04), and higher total cholesterol to HDL ratio (B = 0.12, p = .09), triglycerides (B = 0.10, p = .08), and C-reactive protein (B = 0.08, p = .09) through visceral adiposity; 2) higher mean arterial pressure (B = 0.14, p = .04), lower insulin sensitivity (B = −0.09, p = .08), and higher C-reactive protein (B = 0.12, p = .07) through subcutaneous adiposity; 3) lower insulin sensitivity (B = −0.07, p = .08) and higher total cholesterol to HDL ratio (B = 0.16, p = .03) through liver adiposity; and 4) higher C-reactive protein (B = 0.08, p = .09) through epicardial adiposity. Conclusion Results extend prior evidence by showing that the association of VE with CVD risk in women is linked with specific regional adiposity elevation. Further study of adiposity-related mechanisms in women who experience early decline in vitality may inform clinical targets for CVD prevention.

目的 活力耗竭（VE）与女性心血管疾病（CVD）风险的关联比男性更强。本研究探讨了VE与CVD风险标志物关联的性别差异是否可由VE与局部肥胖的独特关联来解释。 方法 该研究招募了143名（18 - 55岁）无确诊疾病的人员。通过马斯特里赫特问卷评估VE。使用正糖 - 高胰岛素钳夹试验、静息血压测量和抽血来测定CVD指标。使用计算机断层扫描和二维超声心动图测量局部肥胖。这项横断面研究采用路径分析方法，包括相关协变量。 结果 该队列年龄为38.7 ± 8.4岁，其中65%为男性，41%为肥胖者。最终模型拟合良好（χ²(36) = 36.5，p =.45；均方根误差近似值（RMSEA）= 0.009，比较拟合指数（CFI）= 0.999）。对于女性而非男性，该模型显示从VE到以下各项的路径：1）通过内脏脂肪，胰岛素敏感性降低（B = -0.10，p =.04），总胆固醇与高密度脂蛋白比率升高（B = 0.12，p =.09），甘油三酯升高（B = 0.10，p =.08），C - 反应蛋白升高（B = 0.08，p =.09）；2）通过皮下脂肪，平均动脉压升高（B = 0.14，p =.04），胰岛素敏感性降低（B = -0.09，p =.08），C - 反应蛋白升高（B = 0.12，p =.07）；3）通过肝脏脂肪，胰岛素敏感性降低（B = -0.07，p =.08），总胆固醇与高密度脂蛋白比率升高（B = 0.16，p =.03）；4）通过心外膜脂肪，C - 反应蛋白升高（B = 0.08，p =.09）。 结论 研究结果扩展了先前的证据，表明女性中VE与CVD风险的关联与特定局部肥胖增加有关。对活力早期下降的女性中与肥胖相关机制的进一步研究可能为心血管疾病预防提供临床靶点。