While obesity is a known risk factor for premature cardiovascular ageing, the specific impact of body fat distribution has been less clear. A new study analysing data from the UK Biobank suggests that where fat is stored has a significant, and sometimes sex-specific, influence on the biological age of the cardiovascular system.¹
This cross-sectional study analysed data from 21,241 participants in the UK Biobank. Researchers used a machine learning model to predict cardiovascular age based on 126 image-derived traits of vascular function, cardiac motion, and myocardial fibrosis. A cardiovascular ‘age-delta’ was calculated as the difference between this predicted biological age and the participant's chronological age. The volume and distribution of body fat were assessed using whole-body magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA). The association between different fat phenotypes and the cardiovascular age-delta was then evaluated using multivariable linear regression.
The analysis revealed that several fat phenotypes were strong predictors of an increased cardiovascular age-delta (i.e., accelerated ageing) in both sexes. These included visceral adipose tissue volume (β = 0.656; 95% CI, 0.537–0.775; p<0.0001), muscle adipose tissue infiltration (β = 0.183; 95% CI, 0.122–0.244; p=0.0003), and liver fat fraction (β = 1.066; 95% CI, 0.835–1.298; p<0.0001).
Sex-specific associations were also identified. In males, abdominal subcutaneous adipose tissue volume (β = 0.432; 95% CI, 0.269–0.596; p<0.0001) and android fat mass (β = 0.983; 95% CI, 0.64–1.326; p<0.0001) were each associated with an increased age-delta. Conversely, genetically predicted gynoid fat showed an association with a decreased age-delta, suggesting a protective effect. An increased age-delta was also associated with a higher risk of incident atrial fibrillation (HR = 1.16) and type 2 diabetes (HR = 1.29).
These findings underscore that body mass index (BMI) is a weaker predictor of cardiovascular ageing compared to specific measures of fat distribution. The study highlights that different fat depots have varying impacts, with visceral and ectopic fat being particularly detrimental. The authors concluded that, “Shared and sex-specific patterns of body fat are associated with both protective and harmful changes in cardiovascular ageing, highlighting adipose tissue distribution and function as a key target for interventions to extend healthy lifespan.”¹ This reinforces the importance of considering body composition beyond simple weight metrics in cardiovascular risk assessment.²
The study was cross-sectional and conducted in a predominantly European population. The authors note that further research with longitudinal data is needed to understand how biological ageing mediates risk exposures over time. Additionally, future work should aim to generalise these findings to more diverse ancestral populations.
This study was funded by the Medical Research Council (UK), the British Heart Foundation, and the NIHR Imperial College Biomedical Research Centre.
References
1. Losev V, Lu C, Tahasildar S, et al. Sex-specific body fat distribution predicts cardiovascular ageing. Eur Heart J. 2025;46(46):5076–5088. https://doi.org/10.1093/eurheartj/ehaf553
2. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143:e984–1010. https://doi.org/10.1161/CIR.0000000000000973
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